Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | 016355 | ME |
Y | 2080P0202X | Pediatric Cardiologist | MD16355 | ME |
NPI | 1255301974 |
---|---|
Provider Name | Adrian M Moran |
First Address | Scarborough, ME 04074-7173 |
Second Address | Scarborough, ME 04074-7173 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 11/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
292420099 | (05) | ME |
G70861 | (02) |