Provider Demographics
NPI:1821090432
Name:MORALES-MARIN, JOSE (PA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:MORALES-MARIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 2109A
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-714-6581
Mailing Address - Fax:860-714-8311
Practice Address - Street 1:94 WOODLAND ST
Practice Address - Street 2:CANCER CENTER
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1217
Practice Address - Country:US
Practice Address - Phone:860-714-4680
Practice Address - Fax:860-714-8047
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000635363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970000660Medicare ID - Type Unspecified
CTS62883Medicare UPIN