Provider Demographics
NPI:1649253428
Name:MORITZ, ERWIN (MD)
Entity type:Individual
Prefix:
First Name:ERWIN
Middle Name:
Last Name:MORITZ
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 1:3998 FAIR RIDGE DR
Mailing Address - Street 2:STE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2921
Mailing Address - Country:US
Mailing Address - Phone:703-293-9590
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:746 JEFFERSON AVE
Practice Address - Street 2:REGIONAL HOSPITAL OF SCRANTON
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1624
Practice Address - Country:US
Practice Address - Phone:570-348-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035053E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA050091260OtherRR MEDICARE
PA1137430Medicaid
C32654Medicare UPIN
PA050091260OtherRR MEDICARE
PAP01345442Medicare PIN
PA168440Medicare PIN