Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD2005-0134 | NM |
N | 208000000X | Pediatrician | R36492 | NM |
NPI | 1003859943 |
---|---|
Provider Name | Dr. Marcia L Moran |
First Address | Burlington, NC 27215-9533 |
Second Address | Burlington, NC 27215-6853 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 14/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
91926025 | (05) | NM |
I12964 | (02) |