Provider Demographics
NPI:1033190673
Name:MORAN, KEVIN J (DPM)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:MORAN
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:978-466-3206
Mailing Address - Fax:978-466-3241
Practice Address - Street 1:165 MILL ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3242
Practice Address - Country:US
Practice Address - Phone:978-466-3206
Practice Address - Fax:978-466-3241
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1486213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
26816OtherCMSP
918064OtherFIRST HEALTH
042472266OtherPRIVATE HEALTHCARE
480026225OtherRAILROAD MEDICARE
9900803OtherFALLON COMMUNITY HEALTH
7157347OtherUS HEALTHCARE
Y70603OtherMEDICARE B
042472266OtherHEALTHCARE VALUE MGMT
26816OtherHEALTHY START
Y70603OtherBLUE CARE ELECT
7157347OtherAETNA
785962OtherMVP HEALTH CARE
Y70603OtherBLUE SHIELD HMO BLUE
Y70603OtherBLUE SHIELD INDEMNITY
042472266OtherONE HEALTH PLAN
042472266OtherTHREE RIVERS
8296705OtherCIGNA PAL ID
AA2361OtherHARVARD PILGRIM
Y70603OtherMEDICARE B
Y70603OtherBLUE CARE ELECT