Provider Demographics
NPI:1689659898
Name:MORITZ, ERNEST D (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:D
Last Name:MORITZ
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 1:60 TEMPLE ST
Mailing Address - Street 2:7F
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2716
Mailing Address - Country:US
Mailing Address - Phone:203-789-1338
Mailing Address - Fax:203-789-1478
Practice Address - Street 1:60 TEMPLE ST
Practice Address - Street 2:7F
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2716
Practice Address - Country:US
Practice Address - Phone:203-789-1338
Practice Address - Fax:203-789-1478
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT021600207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001216001Medicaid
CT001216001Medicaid
CT290000241Medicare ID - Type Unspecified