Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 78726 | MA |
NPI | 1598774630 |
---|---|
Provider Name | Dr. Kevin Patrick Moriarty |
First Address | Springfield, MA 01199-1001 |
Second Address | Springfield, MA 01107-1381 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 16/01/2019 |