Provider Demographics
NPI:1316936867
Name:MOORE, DAVID W (MD)
Entity type:Individual
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First Name:DAVID
Middle Name:W
Last Name:MOORE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:460 TOTTEN POND RD
Mailing Address - Street 2:C/O MZI
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1991
Mailing Address - Country:US
Mailing Address - Phone:781-890-9933
Mailing Address - Fax:781-890-9930
Practice Address - Street 1:1094 WORCESTER RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-5255
Practice Address - Country:US
Practice Address - Phone:508-879-2550
Practice Address - Fax:508-820-9844
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2009-12-30
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Provider Licenses
StateLicense IDTaxonomies
MA29318207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA029318OtherTUFTS
MA2000000471OtherHPHC
MA1318163OtherBCBS
MA2023296Medicaid
B87058Medicare UPIN
MA2000000471OtherHPHC