Provider Demographics
NPI:1083213557
Name:MORAN, MORGAN E (PA-C)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:E
Last Name:MORAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 BROAD RD STE 2C
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-5103
Mailing Address - Country:US
Mailing Address - Phone:315-492-5915
Mailing Address - Fax:315-492-5741
Practice Address - Street 1:4850 BROAD RD STE 2C
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-5103
Practice Address - Country:US
Practice Address - Phone:315-436-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-25
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant