Healthcare Provider Details

I. General information

NPI: 1881647535
Provider Name (Legal Business Name): JEAN MARGARET MORESI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 LANDMARK DRIVE SUITE 217-219
GLEN BURNIE MD
21061
US

IV. Provider business mailing address

PO BOX 840294
DALLAS TX
75284-0294
US

V. Phone/Fax

Practice location:
  • Phone: 888-276-2223
  • Fax: 972-767-0225
Mailing address:
  • Phone: 888-344-1160
  • Fax: 972-331-3148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberD46165
License Number StateMH
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberD46165
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: