Provider Demographics
NPI:1780657395
Name:MORAN, MARIA T (PHD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:T
Last Name:MORAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:717-531-7010
Mailing Address - Fax:717-531-7102
Practice Address - Street 1:1135 OLD WEST CHOCOLATE AVE, STE 101
Practice Address - Street 2:PENN STATE HERSHEY PHYSICAL MEDICINE & REHABILITATION
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036
Practice Address - Country:US
Practice Address - Phone:717-531-7010
Practice Address - Fax:717-531-7102
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017978103TC0700X
WV826103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00109680OtherRAILROAD MEDICARE
WVCA7344OtherRAILROAD MEDICARE GROUP #
WV9203052000Medicaid
WVP00109680OtherRAILROAD MEDICARE
P65946Medicare UPIN
WVCA7344OtherRAILROAD MEDICARE GROUP #