Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Susanna Dorothy Moore

Individual provider Family Medicine Physician · NPI 1578097556

Susanna Dorothy Moore is an Internal Medicine in Bronx, New York. Qualified in 2020, 6 years ago. Practices with Montefiore Medical Center, a 2,796-clinician group. Licensed in New York.

Years since qualifying
6
Licensed in
NY
In the registry since
2017
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Practice location Address checks out

111 E 210th St
Bronx, NY 10467-2401
Phone: (718) 920-4678
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 303653-01 (NY)

Record details

NPI number1578097556
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedApril 17, 2017
Last updated in NPPESApril 22, 2020
Certification dateApril 22, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Montefiore Medical Center — 2796 clinicians
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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