Provider Demographics
NPI:1447591656
Name:MORALEDA, MANUEL HALCON (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:HALCON
Last Name:MORALEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MANUEL
Other - Middle Name:H
Other - Last Name:MORALEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1 BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-9689
Mailing Address - Country:US
Mailing Address - Phone:269-830-5374
Mailing Address - Fax:
Practice Address - Street 1:1 BUCKINGHAM DR
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-9689
Practice Address - Country:US
Practice Address - Phone:269-830-5374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036642A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01036642AOtherPHYSICIAN LICENSE