Provider Demographics
NPI:1124055447
Name:MOORE, RICHARD ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ANTHONY
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 W RIVER ST STE 22B
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2628
Mailing Address - Country:US
Mailing Address - Phone:401-572-3887
Mailing Address - Fax:401-865-6192
Practice Address - Street 1:148 W RIVER ST STE 22B
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2628
Practice Address - Country:US
Practice Address - Phone:401-572-3887
Practice Address - Fax:401-865-6192
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD20015207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3095363Medicaid
MA3095363Medicaid
MAJ12628Medicare PIN