Provider Demographics
NPI:1700157039
Name:MOHARAN, MICHAEL (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MOHARAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PALOMINO DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-3376
Mailing Address - Country:US
Mailing Address - Phone:781-762-5155
Mailing Address - Fax:
Practice Address - Street 1:15 PALOMINO DR
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-3376
Practice Address - Country:US
Practice Address - Phone:781-762-5155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00312200213ES0103X
MA2383213ES0103X
NYN006472213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery