Individual
MICHAEL MORIARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
1025 SILAS DEANE HWY, WETHERSFIELD, CT 06109
(860) 696-2400
Mailing address
1290 SILAS DEANE HWY, HHC CVO ENROLLMENT, WETHERSFIED, CT 06109-4337
(860) 972-6970
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
63504
CT
207Q00000X
Family Medicine Physician
OS019260
PA
207QA0000X
Adolescent Medicine (Family Medicine) Physician
Primary
63504
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
63504
CT STATE LICENSE
CT
Enumeration date
06/10/2015
Last updated
08/15/2019
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