Provider Demographics
NPI:1386831691
Name:MORAN, KEVIN A
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:A
Last Name:MORAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 PARK RD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3699
Mailing Address - Country:US
Mailing Address - Phone:704-405-0155
Mailing Address - Fax:704-523-5701
Practice Address - Street 1:5110 PARK RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3699
Practice Address - Country:US
Practice Address - Phone:704-405-0155
Practice Address - Fax:704-523-5701
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1224237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist