Provider Demographics
NPI:1811965700
Name:MOREIRA, KATHERYN (MD)
Entity type:Individual
Prefix:
First Name:KATHERYN
Middle Name:
Last Name:MOREIRA
Suffix:
Gender:F
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:PO BOX 869
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46061-0869
Mailing Address - Country:US
Mailing Address - Phone:317-770-6900
Mailing Address - Fax:317-770-6911
Practice Address - Street 1:355 WESTFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1443
Practice Address - Country:US
Practice Address - Phone:317-773-5876
Practice Address - Fax:317-776-0363
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-084823207V00000X
IN01062072A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2494859Medicaid
IN000000481725OtherANTHEM
INQ0434002OtherSHO
IN200103890Medicaid
INMO4138401Medicare PIN
IN000000481725OtherANTHEM
L1162Medicare UPIN
OH2494859Medicaid