=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063674703
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROY N MORCOS, MD, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2008
-----------------------------------------------------
Last Update Date | 08/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 MANOR HILL DR SUITE 300
-----------------------------------------------------
City | CANFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44406-1527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-702-1370
-----------------------------------------------------
Fax | 330-702-0717
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 MANOR HILL DR SUITE 300
-----------------------------------------------------
City | CANFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44406-1527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-702-1370
-----------------------------------------------------
Fax | 330-702-0717
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROY NICOLAS MORCOS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-702-1370
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 35. 053082
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------