Provider Demographics
NPI:1861648974
Name:MOURIA, MICHELLE M (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:MOURIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E NORTH AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4746
Mailing Address - Country:US
Mailing Address - Phone:412-359-4068
Mailing Address - Fax:412-359-6732
Practice Address - Street 1:420 E NORTH AVE STE 304
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4746
Practice Address - Country:US
Practice Address - Phone:412-359-4068
Practice Address - Fax:412-359-6732
Is Sole Proprietor?:No
Enumeration Date:2008-08-09
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUMTL-2017-073208600000X
GUM-2074208600000X
PAMD448564208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102819400Medicaid
PA102819400Medicaid