Individual
DANIELLE A MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1153 CENTRE ST, JAMAICA PLAIN, MA 02130
(617) 983-7000
Mailing address
1153 CENTRE ST, JAMAICA PLAIN, MA 02130-3446
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
016909
NY
363A00000X
Physician Assistant
Primary
PA4801
MA
Other
Enumeration date
09/13/2013
Last updated
12/03/2018
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