Provider Demographics
NPI:1356381594
Name:MORAN, LOUIS J (DO)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:J
Last Name:MORAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2818 NEUSE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2850
Mailing Address - Country:US
Mailing Address - Phone:252-636-4920
Mailing Address - Fax:252-636-4970
Practice Address - Street 1:2818 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2850
Practice Address - Country:US
Practice Address - Phone:252-636-4920
Practice Address - Fax:252-636-4970
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-010012083P0901X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5916885Medicaid
NC5916885Medicaid