Provider Demographics
NPI:1952398828
Name:MORAN, MARTIN J SR (DO)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:J
Last Name:MORAN
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:217 LACKAWANNA AVE
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:PA
Mailing Address - Zip Code:18641-2009
Mailing Address - Country:US
Mailing Address - Phone:570-654-2901
Mailing Address - Fax:570-654-1568
Practice Address - Street 1:217 LACKAWANNA AVE
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:PA
Practice Address - Zip Code:18641-2009
Practice Address - Country:US
Practice Address - Phone:570-654-2901
Practice Address - Fax:570-654-1568
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2022-06-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS009468L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017506690001Medicaid
G90220Medicare UPIN