Doctor Name: | MS. MARYBETH AUCOIN MOORE |
NPI Number: | 1033389192 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C, MPH |
License Number: | 002729 |
Business Practice Address: | 631 Quaker Ln S West Hartford, CT - 061101026 |
Business Phone Number: | 8602335133 |
Business Fax Number: | 8602335212 |
Mailing Address: | 631 Quaker Ln S, WEST HARTFORD |
State: | CT |
Postal Code: | 061101026 |
Phone Number: | 8602335133 |
Fax Number: | 8602335212 |
NPI Enumeration Date: | 03/05/2008 |
NPI Last Update Date: | 04/25/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 002729 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |