Caleb Moore, MD
Individual provider Active NPI Internal Medicine Physician · Waterbury, CT
NPI 1366461790 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1366461790
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 044186 (CT)
- Practice address
- 140 Grandview Ave
Suite #101
Waterbury, CT 06708-2505 - Phone
- (203) 573-7284
- Fax
- (203) 573-7031
- NPI assigned
- Jul 18, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 17, 2020 through Jan 17, 2028
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 044186 | CT | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairfield County Medical Services Inc | Internal Medicine | Past | Accepting new patients |
Interoperability endpoints
- caleb.moore.1@28835.direct.athenahealth.com
- caleb.moore.1@24265.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 044186 | CT | Yes |
Addresses
Primary practice location
140 Grandview Ave
Suite #101
Waterbury, CT 06708-2505
Mailing address
1625 Straits Tpke
Middlebury, CT 06762-1836
Phone (203) 573-9512
Other providers in Waterbury, CT
- Nicole Montello
- Asia Montgomery
- Lorenzo Montgomery
- Holly Montpelier
- Penny Monty-Carbonari
- Chrystal D Moore
- Jazmen Moore
- Lawrence Moore
- Maraejah Moore
- Marvin Moore
All providers in Waterbury, CT · Internal Medicine Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.