Provider Demographics
NPI:1578521027
Name:MORAN, DOROTHY M (RD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:M
Last Name:MORAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 EAST MAIN ST
Mailing Address - Street 2:CAPE COD HOSPITAL DIABETES OUTPATIENT DEPARTMENT
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601
Mailing Address - Country:US
Mailing Address - Phone:508-862-7513
Mailing Address - Fax:508-862-7918
Practice Address - Street 1:171 EAST MAIN ST
Practice Address - Street 2:CAPE COD HOSPITAL DIABETES OUTPATIENT DEPARTMENT
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-862-7513
Practice Address - Fax:508-862-7918
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1243133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0055Medicare ID - Type Unspecified
P46039Medicare UPIN