Basic Information
| Provider Information | |||||||||
| NPI: | 1003896036 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOYER | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 784 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038202549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035774000 | ||||||||
| FaxNumber: | 6035774019 | ||||||||
| Practice Location | |||||||||
| Address1: | 589 W HOLLIS ST | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030621310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035774000 | ||||||||
| FaxNumber: | 6035774019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 06/02/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207NS0135X | 040186 | CT | N | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology | 207N00000X | 13915 | NH | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 4394277 | 05 | CT | MEDICAID |