| Doctor Name: | KEVIN J MORAN |
| NPI Number: | 1033190673 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 1486 |
| Business Practice Address: | 165 Mill St Leominster, MA - 014533242 |
| Business Phone Number: | 9784663206 |
| Business Fax Number: | 9784663241 |
| Mailing Address: | 630 Plantation St, WORCESTER |
| State: | MA |
| Postal Code: | 01605 |
| Phone Number: | 9784663206 |
| Fax Number: | 9784663241 |
| NPI Enumeration Date: | 11/10/2005 |
| NPI Last Update Date: | 10/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 1486 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |