Individual
RICARDO DANIEL MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20 GLENLAKE PKWY, KAISER PERMANENTE-GLENLAKE MEDICAL CENTER, ATLANTA, GA 30328-3473
(770) 677-6075
Mailing address
3495 PIEDMONT RD NE, NINE PIEDMONT CENTER, ATLANTA, GA 30305-1717
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
062261
NC
208600000X
Surgery Physician
2005-00696
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139N5
BCBS NC
NC
05
—
5900993
—
NC
01
—
P00281577
MEDICARE RR
NC
Enumeration date
01/17/2007
Last updated
01/07/2022
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