Provider Demographics
NPI:1760211908
Name:MORICI, KATHRYN (MD MPH CHCQM)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:MORICI
Suffix:
Gender:F
Credentials:MD MPH CHCQM
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD MPH
Mailing Address - Street 1:10 CLUB CART RD
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-8487
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 CLUB CART RD
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-8487
Practice Address - Country:US
Practice Address - Phone:301-465-3139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD452672083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine