Healthcare Provider Details

I. General information

NPI: 1134168669
Provider Name (Legal Business Name): WILLIAM J MORAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 HENSHAW ST
BRIGHTON MA
02135-2905
US

IV. Provider business mailing address

17 HENSHAW ST
BRIGHTON MA
02135-2905
US

V. Phone/Fax

Practice location:
  • Phone: 617-782-0063
  • Fax:
Mailing address:
  • Phone: 617-782-0063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number28607
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: