Provider Demographics
NPI:1679622351
Name:MORAN, JAMES D (LIC AC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:MORAN
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 EVERETT AVE
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-9159
Mailing Address - Country:US
Mailing Address - Phone:413-323-4773
Mailing Address - Fax:
Practice Address - Street 1:21 EVERETT AVE
Practice Address - Street 2:
Practice Address - City:BELCHERTOWN
Practice Address - State:MA
Practice Address - Zip Code:01007-9159
Practice Address - Country:US
Practice Address - Phone:413-323-4773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA167171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist