Organization
MANUEL V MORENO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA L WAGNER (OFFICE MANAGER)
(570) 322-9948
Entity
Organization
Contact information
Practice address
215 E WATER ST, MUNCY, PA 17756-8828
(570) 322-9948
(570) 322-6195
Mailing address
PO BOX 56, MONTOURSVILLE, PA 17754-0056
(570) 323-8091
(570) 322-6195
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD038231L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010564680003
—
PA
Enumeration date
06/26/2007
Last updated
05/19/2008
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