Provider Demographics
NPI:1154482107
Name:MORAITES, RICHARD S (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:MORAITES
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 1:7717 MONTGOMERY ROAD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-4201
Mailing Address - Country:US
Mailing Address - Phone:513-793-4021
Mailing Address - Fax:513-793-4078
Practice Address - Street 1:7717 MONTGOMERY ROAD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-4201
Practice Address - Country:US
Practice Address - Phone:513-793-4021
Practice Address - Fax:513-793-4078
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35021342M207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6126105Medicaid
OHM00110151Medicare ID - Type Unspecified
OH6126105Medicaid