Provider Demographics
NPI:1568416378
Name:MORAN, THEA C (MD)
Entity Type:Individual
Prefix:DR
First Name:THEA
Middle Name:C
Last Name:MORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3700 CARLYLE CLOSE
Mailing Address - Street 2:897
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1871
Mailing Address - Country:US
Mailing Address - Phone:251-342-4295
Mailing Address - Fax:
Practice Address - Street 1:2451 FILLINGIM ST
Practice Address - Street 2:MASTIN BLDG 617
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2238
Practice Address - Country:US
Practice Address - Phone:251-470-5842
Practice Address - Fax:251-470-5809
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL201122085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009968275Medicaid
MS06436563Medicaid
AL16-01157OtherUNITED HEALTH CARE
LA1055883Medicaid
AL009968285Medicaid
FL271086200Medicaid
AL51524025OtherBLUE CROSS
AL51524024OtherBLUE CROSS
ALP00244751Medicare ID - Type UnspecifiedRAILROAD PGBA
FL271086200Medicaid
AL009968285Medicaid