MEDICARE: MANUEL V MORENO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	MD038231L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023079506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANUEL V MORENO MD

Provider Business Mailing Address
First Line	:	PO BOX 56
Second Line	:
City	:	MONTOURSVILLE
State	:	PA
Zip	:	17754-0056
Country	:	US
Telephone Number	:	570-323-8091
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 E WATER ST
Second Line	:
City	:	MUNCY
State	:	PA
Zip	:	17756-8828
Country	:	US
Telephone Number	:	570-546-4243
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2006
Last Update Date	:	05/19/2008

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