Individual
DR. FERNANDO MORENO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-3500
(207) 662-3070
Mailing address
190 RIVERSIDE ST, SUITE 6B, PORTLAND, ME 04103-1073
(207) 661-2000
(207) 661-2033
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD21299
ME
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
MD21299
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154636280
—
ME
Enumeration date
08/12/2010
Last updated
04/28/2017
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