Provider Demographics
NPI:1326010521
Name:MORAN, SUSAN OTT (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:OTT
Last Name:MORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JOYCE
Other - Last Name:OTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 MDG
Mailing Address - Street 2:755 SCOTT CIRCLE
Mailing Address - City:JBPHH
Mailing Address - State:HI
Mailing Address - Zip Code:96853
Mailing Address - Country:US
Mailing Address - Phone:808-448-6291
Mailing Address - Fax:
Practice Address - Street 1:15 MDG
Practice Address - Street 2:755 SCOTT CIRCLE
Practice Address - City:JBPHH
Practice Address - State:HI
Practice Address - Zip Code:96853
Practice Address - Country:US
Practice Address - Phone:808-448-6291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063582L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics