Provider Demographics
NPI:1518262419
Name:MARGUERITE T MORAN, MD, LLC
Entity Type:Organization
Organization Name:MARGUERITE T MORAN, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGUERITE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-889-9220
Mailing Address - Street 1:200 E 33RD ST
Mailing Address - Street 2:SUITE 265
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3322
Mailing Address - Country:US
Mailing Address - Phone:410-889-9220
Mailing Address - Fax:
Practice Address - Street 1:200 E 33RD ST
Practice Address - Street 2:SUITE 265
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3322
Practice Address - Country:US
Practice Address - Phone:410-889-9220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0008093261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD184201300Medicaid
MDOM85MOOtherBLUE CROSS
MD184201300Medicaid
MDOM85MOOtherBLUE CROSS