Provider Demographics
NPI:1821026865
Name:KURT PAUL MORAN MDPC
Entity Type:Organization
Organization Name:KURT PAUL MORAN MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-585-6700
Mailing Address - Street 1:611 MORGAN HWY
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9128
Mailing Address - Country:US
Mailing Address - Phone:570-585-6700
Mailing Address - Fax:570-585-6714
Practice Address - Street 1:611 MORGAN HWY
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-9128
Practice Address - Country:US
Practice Address - Phone:570-585-6700
Practice Address - Fax:570-585-6714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD040998L208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C33151Medicare UPIN
M0190878Medicare ID - Type Unspecified