Active NPI
Raul Abalos Moran, MEDICAL DOCTOR
- Anesthesiology Physician
- Fairfax, VA
National Provider Identifier
1750484275
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 0101036132
- Practice address
- 10734 Main Street
Fairfax, VA 22030 - Phone
- (301) 317-0020
- Fax
- (301) 317-0028
- NPI assigned
- Sep 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 0101036132 | VA | Primary |
Addresses
Primary practice location
10734 Main Street
Fairfax, VA 22030
Mailing address
PO Box 639
Laurel, MD 20725-0639
Phone (301) 317-0020
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0002 | Other | DC | BS INDIVIDUAL |
| 283902 | Other | VA | ANTHEM |
| 9105 | Other | DC | BS GROUP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101036132 | VA | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ambulatory Anesthesia Services Inc | Anesthesiology | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Ambulatory Anesthesia Service
- Anesthesiology Physician
- Fairfox, VA
- NPI 1548363740
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1750484275",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 639",
"city": "LAUREL",
"state": "MD",
"postal_code": "207250639",
"telephone_number": "301-317-0020",
"fax_number": "301-317-0028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10734 MAIN STREET",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "22030",
"telephone_number": "301-317-0020",
"fax_number": "301-317-0028"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORAN",
"first_name": "RAUL",
"middle_name": "ABALOS",
"credential": "MEDICAL DOCTOR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "VA",
"license": "0101036132",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BS INDIVIDUAL",
"identifier": "0002",
"state": "DC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "283902",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BS GROUP",
"identifier": "9105",
"state": "DC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.