Individual
DR. GLENN P MORADIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1301 15TH AVE W, WILLISTON, ND 58801-3821
(701) 774-7401
Mailing address
PO BOX 2537, WILLISTON, ND 58802-2537
(866) 338-6472
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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