Provider Demographics
NPI:1003819848
Name:MORAN, JOSEPH M (DPM)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:MORAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-0343
Mailing Address - Country:US
Mailing Address - Phone:513-932-4961
Mailing Address - Fax:
Practice Address - Street 1:210 MOUND ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1937
Practice Address - Country:US
Practice Address - Phone:513-932-4961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002279213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH480013753OtherRAILROAD MEDICARE
OH0867138Medicaid
OH0579532Medicare PIN