1174528970 NPI number — DR. BRION P MORAN M.D.

Table of content: DR. BRION P MORAN M.D. (NPI 1174528970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174528970 NPI number — DR. BRION P MORAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORAN
Provider First Name:
BRION
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174528970
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3650 MUDDY CREEK RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45238-2057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-451-0500
Provider Business Mailing Address Fax Number:
513-451-0210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 MERCY HEALTH BLVD
Provider Second Line Business Practice Location Address:
SUITE 450
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45211-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-981-6784
Provider Business Practice Location Address Fax Number:
513-215-9397
Provider Enumeration Date:
06/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  35-081018 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3130098 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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