Provider Demographics
NPI:1063564375
Name:MORAN, RUTH E (MD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:E
Last Name:MORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4540 MOCKERNUT LN
Mailing Address - Street 2:
Mailing Address - City:EARLYSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22936-9698
Mailing Address - Country:US
Mailing Address - Phone:434-973-6449
Mailing Address - Fax:
Practice Address - Street 1:9105 STONY POINT DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1999
Practice Address - Country:US
Practice Address - Phone:804-521-8713
Practice Address - Fax:804-282-6567
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010495962085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7200579Medicaid
VA007200579Medicare PIN
VAF63355Medicare UPIN