Healthcare Provider Details

I. General information

NPI: 1003203555
Provider Name (Legal Business Name): ARIC JORDAN MORAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 ATHERHOLT RD
LYNCHBURG VA
24501-2148
US

IV. Provider business mailing address

2410 ATHERHOLT RD
LYNCHBURG VA
24501-2148
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5252
  • Fax:
Mailing address:
  • Phone: 434-200-2747
  • Fax: 434-654-7582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101267125
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101267125
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: