Provider Demographics
NPI:1366433906
Name:MORAN, TERENCE EDWARD (MD)
Entity type:Individual
Prefix:
First Name:TERENCE
Middle Name:EDWARD
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 1:288 GROVELAND ST
Mailing Address - Street 2:UNIT C-3
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6674
Mailing Address - Country:US
Mailing Address - Phone:978-521-8108
Mailing Address - Fax:978-521-8372
Practice Address - Street 1:288 GROVELAND ST
Practice Address - Street 2:UNIT C-3
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6674
Practice Address - Country:US
Practice Address - Phone:978-521-8108
Practice Address - Fax:978-521-8372
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH21339208000000X
MA24027208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E93788Medicare UPIN
J11423Medicare ID - Type Unspecified