MEDICARE: PETER MORAN PH.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	103TC0700X	Clinical Psychologist	3358	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	W03608	OTHER	MA	BLUE CROSS - MA

General Provider Information

NPI Number	:	1700809399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER MORAN PH.D.

Provider Business Mailing Address
First Line	:	397 GROVE ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01605-1223
Country	:	US
Telephone Number	:	774-253-1573
Fax Number	:

Provider Business Practice Location Address
First Line	:	397 GROVE ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01605-1223
Country	:	US
Telephone Number	:	774-253-1573
Fax Number	:

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	04/29/2016

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