Healthcare Provider Details

I. General information

NPI: 1659400729
Provider Name (Legal Business Name): ELIZABETH BOX MORAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 RANDOLPH RD STE B
CHARLOTTE NC
28207
US

IV. Provider business mailing address

PO BOX 60099
CHARLOTTE NC
28260-0099
US

V. Phone/Fax

Practice location:
  • Phone: 704-650-7156
  • Fax:
Mailing address:
  • Phone: 704-446-7800
  • Fax: 704-446-7875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2008-00351
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: