Provider Demographics
NPI:1376632778
Name:MORRIS, MICHAEL S (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:MORRIS
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 1:14955 SHADY GROVE RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-8700
Mailing Address - Country:US
Mailing Address - Phone:301-279-7522
Mailing Address - Fax:301-279-9010
Practice Address - Street 1:14955 SHADY GROVE RD
Practice Address - Street 2:SUITE 240
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8700
Practice Address - Country:US
Practice Address - Phone:301-279-7522
Practice Address - Fax:301-279-9010
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0030027207Y00000X
DCMD17378207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD552180OtherUNITEDHEALTH PROVIDER ID
DC41520001OtherBCBS NCA PROVIDER ID
MD5120441OtherAETNA PROVIDER ID
MD0M46MSOtherBCBS OF MD PROVIDER ID
MD5120441OtherAETNA PROVIDER ID
C62853Medicare UPIN