Healthcare Provider Details

I. General information

NPI: 1982662003
Provider Name (Legal Business Name): KAREN MORAN AYOTTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN MEGHAN MORAN MD

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 01/06/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR DGMC 60MDTS/SGQX
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

1345 INGRID DR
DIXON CA
95620-4218
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-7182
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberA87579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: