Individual
DR. GLENN P MORADIAN
Active
Individual
DR. GLENN P MORADIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
PT11018
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010149530
BS INDIVIDUAL PIN NUMBER
ID
05
—
15042
—
ND
01
—
74070
BC OF IDAHO
UT
05
—
804043200
—
ID
01
—
B4059
BC OF IDAHO
UT
01
—
B5651
BC OF IDAHO
UT
01
—
P00203248
RR MEDICARE NO
ID
Enumeration date
07/08/2005
Last updated
10/17/2008
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