Healthcare Provider Details

I. General information

NPI: 1588850549
Provider Name (Legal Business Name): ELIZABETH A MORAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2007
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 PAYNE ROAD
BLOCK ISLAND RI
02807
US

IV. Provider business mailing address

PO BOX 919
BLOCK ISLAND RI
02807
US

V. Phone/Fax

Practice location:
  • Phone: 401-466-2974
  • Fax:
Mailing address:
  • Phone: 401-466-2974
  • Fax: 401-466-5476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD20927
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36808
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: