Provider Demographics
NPI:1427342401
Name:MORAN, JASON P (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:P
Last Name:MORAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 WESTERN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2415
Mailing Address - Country:US
Mailing Address - Phone:207-661-0200
Mailing Address - Fax:888-368-4071
Practice Address - Street 1:265 WESTERN AVE STE 2
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2415
Practice Address - Country:US
Practice Address - Phone:207-661-0200
Practice Address - Fax:888-368-4071
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD22909207R00000X, 207RH0003X
MAL-247653207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine