Provider Demographics
NPI:1154360287
Name:MORECK, CAROL (PA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:MORECK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 EASTERN SHORE DR
Mailing Address - Street 2:P.O. BOX 49
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5565
Mailing Address - Country:US
Mailing Address - Phone:410-749-0821
Mailing Address - Fax:410-219-5662
Practice Address - Street 1:400 EASTERN SHORE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804
Practice Address - Country:US
Practice Address - Phone:410-543-8240
Practice Address - Fax:410-543-8640
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0000657363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD765991100Medicaid
MDH640Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
MDH640616XMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL