Individual
MS. MARYBETH AUCOIN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, MPH
Contact information
Practice address
631 QUAKER LN S, WEST HARTFORD, CT 06110-1026
(860) 233-5133
(860) 233-5212
Mailing address
631 QUAKER LN S, WEST HARTFORD, CT 06110-1026
(860) 233-5133
(860) 233-5212
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
002729
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002729
LICENSE
CT
Enumeration date
03/05/2008
Last updated
04/25/2012
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