Healthcare Provider Details

I. General information

NPI: 1699720110
Provider Name (Legal Business Name): SCOTT CAMPBELL MORAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8450 DORSEY RUN RD
JESSUP MD
20794-9486
US

IV. Provider business mailing address

10600 WOODSDALE DR
SILVER SPRING MD
20901-1544
US

V. Phone/Fax

Practice location:
  • Phone: 410-724-3078
  • Fax:
Mailing address:
  • Phone: 336-404-7514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01051651A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberD84252
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01051651A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number01051651A
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD84252
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: