Provider Demographics
NPI:1497837207
Name:MORAN, RICHARD E (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:MORAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 LIBERTY STREET
Mailing Address - Street 2:SUITE 506
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323
Mailing Address - Country:US
Mailing Address - Phone:814-432-4000
Mailing Address - Fax:814-432-4002
Practice Address - Street 1:1243 LIBERTY STREET
Practice Address - Street 2:SUITE 506
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16424
Practice Address - Country:US
Practice Address - Phone:814-432-4000
Practice Address - Fax:814-432-4002
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005711L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001011303Medicaid
4342OtherUPMC
MO189251OtherHIGHMARK
MO189251OtherBLUE CROSS BLUE SHIELD
010013205OtherRAILROAD MEDICARE
251498177OtherDEVON
MO189251OtherHIGHMARK
C33123Medicare UPIN