Provider Demographics
NPI:1215102835
Name:MORGAN, DORIS A (PHD)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:A
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W RIDGELY RD
Mailing Address - Street 2:STE 4A
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5145
Mailing Address - Country:US
Mailing Address - Phone:410-561-9584
Mailing Address - Fax:410-561-9587
Practice Address - Street 1:101 W RIDGELY RD
Practice Address - Street 2:STE 4A
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-5145
Practice Address - Country:US
Practice Address - Phone:410-561-9584
Practice Address - Fax:410-561-9587
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1751103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH388I981Medicare PIN