Healthcare Provider Details

I. General information

NPI: 1578564324
Provider Name (Legal Business Name): ROBERT L MORAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6511 SPRINGBROOK AVE
RHINEBECK NY
12572
US

IV. Provider business mailing address

PO BOX 551420
FORT LAUDERDALE FL
33355-1420
US

V. Phone/Fax

Practice location:
  • Phone: 845-334-2819
  • Fax:
Mailing address:
  • Phone: 866-507-5244
  • Fax: 855-851-4405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number162795
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: