Provider Demographics
NPI:1518063056
Name:MORITZ, DEBORAH LYNNE (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNNE
Last Name:MORITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 PARK CIR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-6052
Mailing Address - Country:US
Mailing Address - Phone:740-549-2596
Mailing Address - Fax:740-549-0047
Practice Address - Street 1:161 CLINE AVENUE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907
Practice Address - Country:US
Practice Address - Phone:419-756-5739
Practice Address - Fax:419-756-4968
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054857M207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3600681818OtherCLIA
OH0856720Medicaid
F17719Medicare UPIN
OH3600681818OtherCLIA