Provider Demographics
NPI:1467592378
Name:MORENO, MARIA R (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:R
Last Name:MORENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 EOFF ST
Mailing Address - Street 2:SUITE 704
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3823
Mailing Address - Country:US
Mailing Address - Phone:304-234-8596
Mailing Address - Fax:304-234-8333
Practice Address - Street 1:2000 EOFF ST
Practice Address - Street 2:SUITE 704
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3823
Practice Address - Country:US
Practice Address - Phone:304-234-8596
Practice Address - Fax:304-234-8333
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350766122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2250317Medicaid
NY456256OtherVALUE OPTIONS
WV1057934OtherWV WORKERS COMP.
WV001723127OtherMOUNTAIN STATE BCBS
KY000000220176OtherANTHEM BCBS
OHH39727Medicare UPIN
OH2250317Medicaid