Healthcare Provider Details

I. General information

NPI: 1316107295
Provider Name (Legal Business Name): TIMOTHY PAUL MORAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S COLUMBIA ST CB# 7231
CHAPEL HILL NC
27599-0001
US

IV. Provider business mailing address

333 S COLUMBIA ST CB# 7231
CHAPEL HILL NC
27599-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-962-5136
  • Fax: 919-962-4421
Mailing address:
  • Phone: 919-962-5136
  • Fax: 919-962-4421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number2011-00048
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: