Provider Demographics
NPI:1457348534
Name:MORAN, MARGUERITE T (MD)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:T
Last Name:MORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6080 FALLS ROAD
Mailing Address - Street 2:SUITE #204
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209
Mailing Address - Country:US
Mailing Address - Phone:410-323-2757
Mailing Address - Fax:410-323-2715
Practice Address - Street 1:200 E 33RD ST
Practice Address - Street 2:SUITE 265
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3322
Practice Address - Country:US
Practice Address - Phone:410-889-9220
Practice Address - Fax:410-889-9221
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0008093207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD110182143OtherRAILROAD MEDICARE ID
MD184201300Medicaid
MD0M85MTOtherCARE FIRST MARYLAND
MDE1420001OtherBLUE CHOICE/GHMSI ID#
MDE1420001OtherBLUE CHOICE/GHMSI ID#
MDD01290Medicare UPIN