Provider Demographics
NPI:1437100542
Name:MOORE, JAMES E (MD PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:EDWARD
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:10 COLUMBUS BOULEVARD
Mailing Address - Street 2:4TH-MEDICAL STAFF OFFICE
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106
Mailing Address - Country:US
Mailing Address - Phone:860-837-5560
Mailing Address - Fax:
Practice Address - Street 1:282 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3322
Practice Address - Country:US
Practice Address - Phone:860-545-9778
Practice Address - Fax:860-545-8959
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0548662080N0001X
TXK86662080N0001X
CT0539162080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine