Provider Demographics
NPI:1477512887
Name:MOROG, NICHOLAS W (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:W
Last Name:MOROG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6518 MEADOWRIDGE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6458
Mailing Address - Country:US
Mailing Address - Phone:667-234-8650
Mailing Address - Fax:667-234-8655
Practice Address - Street 1:6518 MEADOWRIDGE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6403
Practice Address - Country:US
Practice Address - Phone:410-368-8650
Practice Address - Fax:410-368-8655
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050812207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0021OtherCAREFIRST-DC
MD520590500Medicaid
MD543443-01OtherCAREFIRST-MD
MD0021OtherCAREFIRST-DC
MD520590500Medicaid