Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 651 | MA |
N | 111NN0400X | Neurology | 1258 | MA |
N | 111NR0200X | Radiology | 651 | MA |
N | 213ER0200X | Radiology | 651 | MA |
NPI | 1689887887 |
---|---|
Provider Name | Dr. Mary Ellen Moore |
First Address | Methuen, MA 01844 |
Second Address | Methuen, MA 01844 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 08/07/2007 |