Individual
QADARA FARIH MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
374 GRAND AVE, NEW HAVEN, CT 06513-3733
(203) 777-7411
(203) 777-6508
Mailing address
374 GRAND AVE, NEW HAVEN, CT 06513-3733
(203) 777-7411
(203) 777-6508
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
001633
CT
363AM0700X
Medical Physician Assistant
012904
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012904
NEW YORK STATE (LICENSE NUMBER)
NY
01
—
1066955
NCCPA CERTIFICATION
—
01
—
11485065
CAQH
CT
01
—
38064
CONNECTICUT CONNECTICUT CONTROLLED SUBSTANCE
CT
01
—
6543809
NEW YORK STATE (CERTIFICATE NUMBER)
NY
Enumeration date
05/12/2006
Last updated
03/07/2023
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