QADARA FARIH MOORE (NPI# 1821049206) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821049206 |
| Entity Type | Individual |
| Full Name | QADARA FARIH MOORE |
| Credential | PA-C |
| Practice Address |
374 Grand Ave New Haven CT 06513-3733 |
| Practice Telephone | 2037777411 |
| Practice Fax Number | 2037776508 |
| Mailing Telephone | 2037777411 |
| Mailing Fax Number | 2037776508 |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2008-11-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
012904 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
001633 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | NEW YORK STATE (CERTIFICATE NUMBER) | 6543809 | 01 |
| NCCPA CERTIFICATION | 1066955 | 01 | |
| DEA REGISTRATION | MM1291614 | 01 | |
| NY | NEW YORK STATE (LICENSE NUMBER) | 012904 | 01 |
| CT | CONNECTICUT CONNECTICUT CONTROLLED SUBSTANCE | 38064 | 01 |
| CT | CAQH | 11485065 | 01 |
| Street Address |
374 GRAND AVE |
| City | NEW HAVEN |
| State | CT |
| Zip Code | 06513-3733 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770582884 | Mary D Moller | Clinical Nurse Specialist | 374 Grand Ave, New Haven, CT 06513-3733 | 2005-07-20 |
| 1528669181 | Marisol Orth | Nurse Practitioner | 374 Grand Ave, New Haven, CT 06513-3733 | 2020-11-02 |
| 1851999874 | Ornella S Merino | Marriage & Family Therapist | 374 Grand Ave, New Haven, CT 06513-3733 | 2020-10-12 |
| 1043855521 | Joel Daniel Newman Bluman | Family Medicine | 374 Grand Ave, New Haven, CT 06513-3733 | 2019-11-08 |
| 1790215093 | Brian Padilla | Psychologist | 374 Grand Ave, New Haven, CT 06513-3733 | 2017-06-19 |
| 1346792355 | Quest Diagnostics LLC | Clinical Medical Laboratory | 374 Grand Ave, First Floor, New Haven, CT 06511 | 2016-10-26 |
| 1083078695 | Kyle Elligers | Family Medicine | 374 Grand Ave, New Haven, CT 06513-3733 | 2016-04-09 |
| 1073970224 | Kelly Elizabeth Gaffney | Dietitian, Registered | 374 Grand Ave, New Haven, CT 06513-3733 | 2016-01-19 |
| 1811353634 | Lori Goeschel | Dietitian, Registered | 374 Grand Ave, New Haven, CT 06513-3733 | 2016-01-08 |
| 1720468317 | Sandra Gisela Williams | Student in an Organized Health Care Education/Training Program | 374 Grand Ave, Fair Haven Clinic, New Haven, CT 06513-3733 | 2015-06-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366906141 | Edward Rivera | Case Manager/Care Coordinator | 458 Grand Ave., Suite 103, New Haven, CT 06513 | 2019-01-25 |
| 1134698442 | Village of Angels Home Health Care LLC | Respite Care | 470 James Street, Suite 007, New Haven, CT 06513 | 2018-11-15 |
| 1609358068 | Sarah Khalil | Pharmacist | 745 Foxon Road, East Haven, CT 06513 | 2018-09-02 |
| 1912358375 | Domanice Poindexter | Nurse Practitioner | Caremore Health, 444 Foxon Rd, East Haven, CT 06513 | 2016-06-28 |
| 1568839876 | My Fair Haven Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 72 Grand Ave, New Haven, CT 06513 | 2015-08-24 |
| 1871979567 | Sankofa Counseling LLC | Community/Behavioral Health | 64 Thompson St Ste A101, East Haven, CT 06513 | 2015-08-04 |
| 1578967287 | Curtis Stewart | Pharmacy Technician | 661 Thompson Street, East Haven, CT 06513 | 2014-10-09 |
| 1548686322 | Davis Group LLC | Social Worker | 30 Grand Ave, New Haven, CT 06513 | 2014-03-17 |
| 1124459615 | James Lucas IIi | Dietitian, Registered | 167 Old Foxon Road, Unit 30b, New Haven, CT 06513 | 2013-12-09 |
| 1609206135 | Spretha Kadavath | Dentist | 50 Grand Ave, New Haven, CT 06513 | 2013-11-19 |
| Find all providers in zip 06513 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790319655 | Erin Kelly Flynn | Physician Assistant | 464 Congress Ave # Suie260, New Haven, CT 06519-1361 | 2020-02-28 |
| 1659919702 | Jeniece Kayla Wert | Physician Assistant | 100 Church Street South, Suite A230 Room A235, New Haven, CT 06519-1703 | 2019-12-18 |
| 1588121354 | Jason Michael Nies | Physician Assistant | 20 York St # 218, New Haven, CT 06510-3220 | 2019-02-27 |
| 1902334436 | Lauren Veronica Boggs | Physician Assistant | 45 Ley St, New Haven, CT 06512-3921 | 2017-05-29 |
| 1831353853 | Dina Weiner | Physician Assistant | 840 Howard Ave Fl 1, New Haven, CT 06519-1106 | 2008-07-18 |
| 1528244027 | Gerald Kayingo | Physician Assistant | 211 Fountain St, Apt 12, New Haven, CT 06515-1979 | 2008-01-14 |
| 1821219783 | Susanne Atkins | Physician Assistant | 175 Sherman Avenue, New Haven, CT 06511 | 2007-05-01 |
| 1023133626 | John Sceppa | Physician Assistant | Yale -new Haven Hospital, 20 York St., New Haven, CT 06510-3202 | 2007-03-20 |
| 1922147578 | Janice Decho | Physician Assistant | 20 York St Cb- 2041, New Haven, CT 06504-8900 | 2007-02-06 |
| 1578613964 | Brian Patrick Munday | Physician Assistant | 800 Howard Ave Lower Level, Comprehensive Epilepsy Center LLCi 716, New Haven, CT 06520-8018 | 2007-01-10 |
| Find all providers in NEW HAVEN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.