Provider Demographics
NPI:1790255511
Name:MORMAN, MARY GEORGIANNA (RCS)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:GEORGIANNA
Last Name:MORMAN
Suffix:
Gender:F
Credentials:RCS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5110 TIDE VLG
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4594
Mailing Address - Country:US
Mailing Address - Phone:815-712-3140
Mailing Address - Fax:
Practice Address - Street 1:5110 TIDE VLG
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4594
Practice Address - Country:US
Practice Address - Phone:815-712-3140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-31
Deactivation Date:2018-12-12
Deactivation Code:
Reactivation Date:2018-12-31
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography