Provider Demographics
NPI:1831214535
Name:MORAN, KURT PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:PAUL
Last Name:MORAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10 GREEN RIDGE ST
Mailing Address - Street 2:SUITE#2
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509-1828
Mailing Address - Country:US
Mailing Address - Phone:570-585-6700
Mailing Address - Fax:570-585-6714
Practice Address - Street 1:10 GREENRIDGE STREET
Practice Address - Street 2:SUITE#2
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509
Practice Address - Country:US
Practice Address - Phone:570-585-6700
Practice Address - Fax:570-585-6714
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD040998L207R00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA107989OtherMEDICARE
PA010081100OtherFEDERAL BLACK LUNG
PA001126OtherFIRST PRIORITY HEALTH
PA190878OtherPA BLUE CROSS PERSONAL CHOICE
PA190878OtherFDLIC FIRST PRIORITY LIFE
PA110136508OtherRAILROAD MEDICARE
PA190878OtherPENNSYLVANIA BLUE SHIELD
PA001126OtherCHAMPUS
PA507828OtherAETNA
PA107989OtherMEDICARE
PA507828OtherAETNA