Healthcare Provider Details

I. General information

NPI: 1063420636
Provider Name (Legal Business Name): MICHAEL MORITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S CEDAR CREST BLVD SUITE 210
ALLENTOWN PA
18103-6224
US

IV. Provider business mailing address

PO BOX 783311
PHILADELPHIA PA
19178-3311
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-8506
  • Fax: 610-402-1682
Mailing address:
  • Phone: 484-884-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberMD026332E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: