Individual
MARK E MORAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
22890 VIRGIL H GOODE HWY, BOONES MILL, VA 24065
(540) 334-5511
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110001699
VA
363AM0700X
Medical Physician Assistant
0110001699
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010010942
—
VA
Enumeration date
05/24/2006
Last updated
12/08/2025
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