1538127865 NPI number — DR. PETER CHARLES MORAN MD

Table of content: DR. PETER CHARLES MORAN MD (NPI 1538127865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538127865 NPI number — DR. PETER CHARLES MORAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORAN
Provider First Name:
PETER
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1538127865
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLEBROOK
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03576-0206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-237-4262
Provider Business Mailing Address Fax Number:
603-353-0412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 FIRST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLEBROOK
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03576-3128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-237-4262
Provider Business Practice Location Address Fax Number:
603-353-0412
Provider Enumeration Date:
05/03/2006

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: 207Q00000X , with the licence number:  13072 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1012501 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3846319 . This is a "CIGNA PROV #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 8001191 . This is a "LADIES FIRST ID#" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: RE8678 . This is a "NHIC PROV #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 01YP05246MA02 . This is a "BCBS OF NH PROV#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 200999212 . This is a "TAX ID" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30206064 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 71840 . This is a "HPHC PROV #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 00069207 . This is a "BCBS OF VT PROV #" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 4149147 . This is a "MVP" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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