Individual provider Active NPI

Mary Lavin Mooradian, D.C.

  • Chiropractor
  • New London, CT
National Provider Identifier
1598706160
Registry record updated Nov 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
000593 Issued in CT
Practice address
377 Colman St
New London, CT 06320-3713
Phone
(860) 444-6363
Fax
(860) 443-3314
NPI assigned
Jun 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 000593 CT Primary

Addresses

Primary practice location

377 Colman St
New London, CT 06320-3713

Mailing address

377 Colman St
New London, CT 06320-3713
Phone (860) 444-6363

Other names 1

  • Dr. Mary Lavin Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060802000452 CT Practitioner - Chiropractic 2961415278

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
National College of Chiropractic, 1986
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

774 Broad St Ext
Waterford, CT 06385-1303

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
000593CTMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ewcw LLC Chiropractor CurrentSince Aug 25, 2025 Accepting new patients
Eastern Shore Chiropractic Center, L.L.C. Chiropractor PastSince Sep 1, 2006 Accepting new patients

Locations

774 Broad Street Ext
#2
Waterford, CT 06385

774 Broad Street Ext
Waterford, CT 06385
Phone (860) 444-6363

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226620800000",
    "number": "1598706160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "377 COLMAN ST",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063203713",
            "telephone_number": "860-444-6363",
            "fax_number": "860-443-3314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "377 COLMAN ST",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063203713",
            "telephone_number": "860-444-6363",
            "fax_number": "860-443-3314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORADIAN",
        "first_name": "MARY",
        "middle_name": "LAVIN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2008-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CT",
            "license": "000593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "LAVIN",
            "prefix": "DR.",
            "credential": "D.C.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in New London, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.