Provider Demographics
NPI:1386360725
Name:MORAN, NEHAMA (NP)
Entity type:Individual
Prefix:
First Name:NEHAMA
Middle Name:
Last Name:MORAN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 CONCOURSE CIRCLE
Mailing Address - Street 2:SUITE 103; UNIT 392
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2054
Mailing Address - Country:US
Mailing Address - Phone:410-440-1400
Mailing Address - Fax:
Practice Address - Street 1:20 CRAIGTOWN RD
Practice Address - Street 2:
Practice Address - City:PORT DEPOSIT
Practice Address - State:MD
Practice Address - Zip Code:21904-1801
Practice Address - Country:US
Practice Address - Phone:410-440-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR207674363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner