Basic Information
| Provider Information | |||||||||
| NPI: | 1578545943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORCOS | ||||||||
| FirstName: | ROY | ||||||||
| MiddleName: | NICOLAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636988 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452636988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889402722 | ||||||||
| FaxNumber: | 5136328898 | ||||||||
| Practice Location | |||||||||
| Address1: | 8423 MARKET ST | ||||||||
| Address2: | STE 101 | ||||||||
| City: | BOARDMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445126778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307298700 | ||||||||
| FaxNumber: | 3307298701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 10/05/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35053082 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0624319 | 05 | OH | MEDICAID | H143710 | 01 | OH | MEDICARE PTAN | OTHER |