Provider Demographics
NPI:1528374451
Name:MORAN, KATHERINE VICTORIA (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:VICTORIA
Last Name:MORAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:VICTORIA
Other - Last Name:KRAUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:455 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3403
Mailing Address - Country:US
Mailing Address - Phone:215-793-4546
Mailing Address - Fax:215-793-9007
Practice Address - Street 1:455 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3403
Practice Address - Country:US
Practice Address - Phone:215-793-4546
Practice Address - Fax:215-793-9007
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054477363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical