Provider Demographics
NPI:1164477998
Name:MORANDO, DONALD WAIN (DO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WAIN
Last Name:MORANDO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SINGLETON RIDGE RD
Mailing Address - Street 2:ATTENTION PATIENT ACCOUNTING
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9142
Mailing Address - Country:US
Mailing Address - Phone:843-234-6995
Mailing Address - Fax:
Practice Address - Street 1:8004 MYRTLE TRACE DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8945
Practice Address - Country:US
Practice Address - Phone:843-234-8939
Practice Address - Fax:843-234-8959
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC82256207Q00000X, 207Q00000X
NC2007-01854207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC822569Medicaid
KY64049984Medicaid
NC5911080Medicaid
KY0664911Medicare PIN
KY5491Medicare PIN
KYP00460065Medicare PIN
KYC45042Medicare UPIN
NC2593531Medicare PIN
KY6649Medicare PIN
NC1514GOtherBCBS
KY0549030Medicare PIN
KY0549109Medicare PIN
KY0019366Medicare PIN
KY64049984Medicaid
KY3331061Medicare PIN
KY8001Medicare PIN