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NPI Code Detail

MEDICARE: JOSE MORALES-MARIN PA

MEDICARE:   JOSE  MORALES-MARIN  PA
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
1363A00000XPhysician Assistant000635CT

General Provider Information

NPI Number : 1821090432
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSE MORALES-MARIN PA
Provider Business Mailing Address
First Line : 1000 ASYLUM AVE
Second Line : SUITE 2109A
City : HARTFORD
State : CT
Zip : 06105-1770
Country : US
Telephone Number : 860-714-6581
Fax Number : 860-714-8311
Provider Business Practice Location Address
First Line : 94 WOODLAND ST
Second Line : CANCER CENTER
City : HARTFORD
State : CT
Zip : 06105-1217
Country : US
Telephone Number : 860-714-4680
Fax Number : 860-714-8047
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2005
Last Update Date : 02/27/2009

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Directions to “ JOSE MORALES-MARIN PA” Practice Location

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