MEDICARE: MORGAN E MORAN PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1083213557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN E MORAN PA-C

Provider Business Mailing Address
First Line	:	4850 BROAD RD STE 2C
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13215-5103
Country	:	US
Telephone Number	:	315-492-5915
Fax Number	:	315-492-5741

Provider Business Practice Location Address
First Line	:	4850 BROAD RD STE 2C
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13215-5103
Country	:	US
Telephone Number	:	315-436-5046
Fax Number	:

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

Provider Enumeration Date	:	10/25/2020
Last Update Date	:	02/01/2022

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