Provider Demographics
NPI:1538127865
Name:MORAN, PETER CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:CHARLES
Last Name:MORAN
Suffix:
Gender:M
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:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:COLEBROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03576-0206
Mailing Address - Country:US
Mailing Address - Phone:603-237-4262
Mailing Address - Fax:603-353-0412
Practice Address - Street 1:6 FIRST ST
Practice Address - Street 2:
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576-3128
Practice Address - Country:US
Practice Address - Phone:603-237-4262
Practice Address - Fax:603-353-0412
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012501Medicaid
NH3846319OtherCIGNA PROV #
VT8001191OtherLADIES FIRST ID#
NHRE8678OtherNHIC PROV #
NH01YP05246MA02OtherBCBS OF NH PROV#
NH200999212OtherTAX ID
NH30206064Medicaid
NH71840OtherHPHC PROV #
VT00069207OtherBCBS OF VT PROV #
NH4149147OtherMVP