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General NPI Number Information
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NPI Number | 1992910830
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Entity Type | Individual
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Provider Name | EDWARD MORAN JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 71 WAYNE ST
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City | FORT GAY
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State | WV
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Zip | 25514-8518
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Country | US
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Telephone | 304-648-5544
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 1680
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City | HUNTINGTON
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State | WV
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Zip | 25717-1680
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Country | US
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Telephone | 304-697-1396
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Fax | 304-697-2086
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 22569
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 22569
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 22569
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License Number State | WV
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