Provider Demographics
NPI:1881647535
Name:MORESI, JEAN MARGARET (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARGARET
Last Name:MORESI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 840294
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0294
Mailing Address - Country:US
Mailing Address - Phone:888-344-1160
Mailing Address - Fax:972-331-3148
Practice Address - Street 1:810 LANDMARK DRIVE
Practice Address - Street 2:SUITE 217-219
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:888-276-2223
Practice Address - Fax:972-767-0225
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MHD46165207ND0900X
MDD46165207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD776838900Medicaid
MDG74930Medicare UPIN
MDW660JOMedicare ID - Type UnspecifiedGROUP