Provider Demographics
NPI:1568706463
Name:MORAN, ROBERT MASSEY (PA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MASSEY
Last Name:MORAN
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:48 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2541
Mailing Address - Country:US
Mailing Address - Phone:508-757-0330
Mailing Address - Fax:508-752-9850
Practice Address - Street 1:48 ELM ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2541
Practice Address - Country:US
Practice Address - Phone:508-757-0330
Practice Address - Fax:508-752-9850
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant