Provider Demographics
NPI:1942285739
Name:MORELAND, DOUGLAS B (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:B
Last Name:MORELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40 GEORGE KARL BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7183
Mailing Address - Country:US
Mailing Address - Phone:716-218-1000
Mailing Address - Fax:
Practice Address - Street 1:40 GEORGE KARL BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7183
Practice Address - Country:US
Practice Address - Phone:716-218-1000
Practice Address - Fax:716-200-1857
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161777 1207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
140004319OtherRAILROAD MEDICARE
NY000525938003OtherBLUE CROSS BLUE SHIELD
NY0607773OtherINDEPENDENT HEALTH
NY00010121701OtherUNIVERA HEALTHCARE
NY040426001228OtherFIDELISCARE NEW YORK
NY00010121701OtherUNIVERA HEALTHCARE
NY000525938003OtherBLUE CROSS BLUE SHIELD
11984CMedicare ID - Type Unspecified