Provider Demographics
NPI: | 1437492238 |
---|---|
Name: | MORRIS, MICHAEL ANTHONY (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | MICHAEL |
Middle Name: | ANTHONY |
Last Name: | MORRIS |
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: | 331 OAK MANOR DR STE 201 |
Mailing Address - Street 2: | |
Mailing Address - City: | GLEN BURNIE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21061-5555 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 443-333-1894 |
Mailing Address - Fax: | 410-886-6991 |
Practice Address - Street 1: | 331 OAK MANOR DR STE 201 |
Practice Address - Street 2: | |
Practice Address - City: | GLEN BURNIE |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21061-5555 |
Practice Address - Country: | US |
Practice Address - Phone: | 443-333-1894 |
Practice Address - Fax: | 410-886-6991 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2013-03-29 |
Last Update Date: | 2024-02-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | D0082170 | 207U00000X, 2083C0008X, 2085R0202X |
NY | 292741 | 2085R0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No | 207U00000X | Allopathic & Osteopathic Physicians | Nuclear Medicine | |
No | 2083C0008X | Allopathic & Osteopathic Physicians | Preventive Medicine | Clinical Informatics |