Provider Demographics
NPI:1831132497
Name:MOREAU, JOAN L (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:L
Last Name:MOREAU
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3 HOSPITAL DR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9362
Mailing Address - Country:US
Mailing Address - Phone:570-523-7509
Mailing Address - Fax:570-523-7599
Practice Address - Street 1:3 HOSPITAL DR
Practice Address - Street 2:SUITE 308
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9362
Practice Address - Country:US
Practice Address - Phone:570-523-7509
Practice Address - Fax:570-523-7599
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD020047E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA145969Medicare ID - Type Unspecified
PAC31769Medicare UPIN