Provider Demographics
NPI:1063442515
Name:MORAN, MICHAEL PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:MORAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 CYNWOOD DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3886
Mailing Address - Country:US
Mailing Address - Phone:410-221-1185
Mailing Address - Fax:410-221-1187
Practice Address - Street 1:556 CYNWOOD DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3886
Practice Address - Country:US
Practice Address - Phone:410-221-1185
Practice Address - Fax:410-221-1187
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD36860207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
6168MPOtherBCBS
MD072141700Medicaid
6168MPMedicare ID - Type Unspecified