MEDICARE: MARY MORAN 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	207RR0500X	Rheumatology Physician	036-065620	IL

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	:	1699729657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MORAN MD

Provider Business Mailing Address
First Line	:	16 FAHEY ST STE 202
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-6029
Country	:	US
Telephone Number	:	207-930-6772
Fax Number	:	207-930-6709

Provider Business Practice Location Address
First Line	:	16 FAHEY ST STE 202
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-6029
Country	:	US
Telephone Number	:	207-930-6772
Fax Number	:	207-930-6709

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	01/11/2016

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Directions to “ MARY MORAN MD” Practice Location

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