Provider Demographics
NPI:1982680039
Name:MORAVEC, JOSEPH J (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:MORAVEC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 CONGRESS AVENUE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-4427
Mailing Address - Country:US
Mailing Address - Phone:513-772-2442
Mailing Address - Fax:513-772-2844
Practice Address - Street 1:1130 CONGRESS AVENUE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-4427
Practice Address - Country:US
Practice Address - Phone:513-772-2442
Practice Address - Fax:513-772-2844
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036275208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN64111111Medicaid
OH0384301Medicaid
OHA78069Medicare UPIN
OH0384301Medicaid