Healthcare Provider Details

I. General information

NPI: 1487247227
Provider Name (Legal Business Name): PAUL DENNIS MORAN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 MONUMENT AVE
RICHMOND VA
23226-1452
US

IV. Provider business mailing address

5500 MONUMENT AVE
RICHMOND VA
23226-1452
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-3752
  • Fax:
Mailing address:
  • Phone: 804-288-3752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2101000259
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: