Provider Demographics
NPI:1386631604
Name:MORO, ROBERT P (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:MORO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3550
Mailing Address - Country:US
Mailing Address - Phone:781-324-2600
Mailing Address - Fax:781-322-5454
Practice Address - Street 1:554 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-3550
Practice Address - Country:US
Practice Address - Phone:781-324-2600
Practice Address - Fax:781-322-5454
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1601652Medicaid
MD1601652Medicaid
MAA22400Medicare UPIN
MAY35046Medicare ID - Type UnspecifiedMEDICARE
MA714689Medicare UPIN