Provider Demographics
NPI:1124004650
Name:PETER C MORAN MD
Entity Type:Organization
Organization Name:PETER C MORAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-521-0900
Mailing Address - Street 1:350 MAIN ST
Mailing Address - Street 2:STE 3
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-4023
Mailing Address - Country:US
Mailing Address - Phone:978-521-0900
Mailing Address - Fax:978-521-3335
Practice Address - Street 1:350 MAIN ST
Practice Address - Street 2:STE 3
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-4023
Practice Address - Country:US
Practice Address - Phone:978-521-0900
Practice Address - Fax:978-521-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60311207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3172520Medicaid
G64207Medicare UPIN
A23318Medicare ID - Type Unspecified