Provider Demographics
NPI:1225025307
Name:MORAN, GEORGE W (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:W
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 1:200 E 33RD ST
Mailing Address - Street 2:SUITE 265
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3322
Mailing Address - Country:US
Mailing Address - Phone:410-889-6639
Mailing Address - Fax:410-889-9221
Practice Address - Street 1:200 E 33RD ST
Practice Address - Street 2:SUITE 265
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3322
Practice Address - Country:US
Practice Address - Phone:410-889-6639
Practice Address - Fax:410-889-9221
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD17346207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS446-0001OtherBLUE CHOICE/GHMSI ID#
MDKBX6OtherBC/BS ID#
MD375MMedicare ID - Type Unspecified
MDKBX6OtherBC/BS ID#