Individual
DR. STEPHANIE A MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
55 FRUIT ST # 800, DEPARTMENT OF CARDIOVASCULAR MEDICINE, BOSTON, MA 02114-2621
(617) 726-9554
Mailing address
71 OLD PICKARD RD, CONCORD, MA 01742-4723
(617) 763-2263
Taxonomy
Speciality
Code
Description
License number
State
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
Primary
54742
KY
207RC0000X
Cardiovascular Disease Physician
222943
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2083795
—
MA
05
—
7100722310
—
KY
Enumeration date
11/09/2005
Last updated
10/25/2022
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