Active NPI
Qadara Farih Moore, PA-C
- Medical Physician Assistant
- New Haven, CT
National Provider Identifier
1821049206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 001633
- Practice address
- 374 Grand Ave
New Haven, CT 06513-3733 - Phone
- (203) 777-7411
- Fax
- (203) 777-6508
- NPI assigned
- May 12, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 001633 | CT | Primary |
| Medical Physician Assistant | 363AM0700X | 012904 | NY |
Addresses
Primary practice location
374 Grand Ave
New Haven, CT 06513-3733
Mailing address
374 Grand Ave
New Haven, CT 06513-3733
Phone (203) 777-7411
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6543809 | Other | NY | NEW YORK STATE (CERTIFICATE NUMBER) |
| 1066955 | Other | NCCPA CERTIFICATION | |
| 012904 | Other | NY | NEW YORK STATE (LICENSE NUMBER) |
| 11485065 | Other | CT | CAQH |
| 38064 | Other | CT | CONNECTICUT CONNECTICUT CONTROLLED SUBSTANCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001633 | CT | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1821049206",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "374 GRAND AVE",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065133733",
"telephone_number": "203-777-7411",
"fax_number": "203-777-6508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "374 GRAND AVE",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065133733",
"telephone_number": "203-777-7411",
"fax_number": "203-777-6508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "QADARA",
"middle_name": "FARIH",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-12",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CT",
"license": "001633",
"primary": true
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NY",
"license": "012904",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW YORK STATE (CERTIFICATE NUMBER)",
"identifier": "6543809",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCCPA CERTIFICATION",
"identifier": "1066955",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW YORK STATE (LICENSE NUMBER)",
"identifier": "012904",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11485065",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONNECTICUT CONNECTICUT CONTROLLED SUBSTANCE",
"identifier": "38064",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.