Provider Demographics
NPI:1134354087
Name:OFTEDAL MORENO, KARI L (MD)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:L
Last Name:OFTEDAL MORENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:L
Other - Last Name:OFTEDAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2250
Mailing Address - Country:US
Mailing Address - Phone:717-544-4940
Mailing Address - Fax:717-544-4149
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-544-4940
Practice Address - Fax:717-544-4149
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD444627207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine