Healthcare Provider Details

I. General information

NPI: 1578093647
Provider Name (Legal Business Name): JAMES MORAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 07/21/2022
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 E WOODLAND AVE STE 200
SPRINGFIELD PA
19064-3956
US

IV. Provider business mailing address

376 LAFAYETTE RD STE 202
SPARTA NJ
07871-3560
US

V. Phone/Fax

Practice location:
  • Phone: 610-690-4471
  • Fax: 610-690-4474
Mailing address:
  • Phone: 908-684-3005
  • Fax: 908-684-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number25MB11272300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT017992
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: