Provider Demographics
NPI:1710271986
Name:MORAN, ERIN KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:KATHLEEN
Last Name:MORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4748
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD609085662085R0202X, 2085R0202X
MN1069742085R0202X
IL125059292208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0406480OtherL&I-SEATTLE RADIOLOGY
WA0406473OtherL&I-RADIA REST OF WA
WA0406477OtherL&I-SWEDISH RADIA EDMONDS
WA0406482OtherL&I-EVERGREEN RADIA
WA0406476OtherL&I-RADIA KING COUNTY
WA0406479OtherL&I-SOUTH SOUND RADIOLOGY
WA2123818Medicaid