Provider Demographics
NPI:1831356591
Name:O'RIORDAN, MOIRA (MD)
Entity type:Individual
Prefix:DR
First Name:MOIRA
Middle Name:
Last Name:O'RIORDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CORPORATE DR STE 325
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6295
Mailing Address - Country:US
Mailing Address - Phone:203-696-3642
Mailing Address - Fax:203-337-9731
Practice Address - Street 1:1 CORPORATE DR STE 325
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6295
Practice Address - Country:US
Practice Address - Phone:203-696-3642
Practice Address - Fax:203-337-9731
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT556982085R0202X
IDM-122982085R0202X
WAMD602925022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2021771Medicaid
WA324782OtherL & I PROVIDER NUMBER
ID1831356591Medicaid
WAG8912212Medicare PIN
WAG8912208Medicare PIN
WAG8912209Medicare PIN
ID20004671Medicare PIN
WAP01162810Medicare PIN
WAG8912211Medicare PIN
WA324780OtherL & I PROVIDER NUMBER
WAG8912210Medicare PIN