Basic Information
| Provider Information | |||||||||
| NPI: | 1154360287 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORECK | ||||||||
| FirstName: | CAROL | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 EASTERN SHORE DR | ||||||||
| Address2: | P.O. BOX 49 | ||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218045565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107490821 | ||||||||
| FaxNumber: | 4102195662 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 EASTERN SHORE DR | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105438240 | ||||||||
| FaxNumber: | 4105438640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 08/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | C0000657 | MD | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | C0000657 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 765991100 | 05 | MD | MEDICAID |