MEDICARE: DR. MOIRA KATHERINE CHRISTOUDIAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	NA	NJ

General Provider Information

NPI Number	:	1114139110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOIRA KATHERINE CHRISTOUDIAS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 416457
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-6457
Country	:	US
Telephone Number	:	973-656-6280
Fax Number	:	973-290-7495

Provider Business Practice Location Address
First Line	:	100 MADISON AVE
Second Line	:	BOX 152
City	:	MORRISTOWN
State	:	NJ
Zip	:	07960-6136
Country	:	US
Telephone Number	:	973-971-4166
Fax Number	:	973-290-7152

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	09/08/2014

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