Provider Demographics
NPI:1184657306
Name:MARIA E MORA MD PA
Entity Type:Organization
Organization Name:MARIA E MORA MD PA
Other - Org Name:MIDDLEBURG PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-861-1034
Mailing Address - Street 1:91 BRANSCOMB RD STE 3
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-7222
Mailing Address - Country:US
Mailing Address - Phone:904-861-1034
Mailing Address - Fax:904-861-1037
Practice Address - Street 1:91 BRANSCOMB RD STE 3
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-7222
Practice Address - Country:US
Practice Address - Phone:904-861-1034
Practice Address - Fax:904-861-1037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X
FLPA9104224363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271515500Medicaid