Provider Demographics
NPI:1871562512
Name:MOORMA, KARIN (MD)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:MOORMA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 DILLMONT DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-6458
Mailing Address - Country:US
Mailing Address - Phone:614-431-1634
Mailing Address - Fax:
Practice Address - Street 1:55 DILLMONT DR
Practice Address - Street 2:SUITE 102
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-6458
Practice Address - Country:US
Practice Address - Phone:614-431-1634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055800207V00000X
OH35-05-5800-M174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0829689Medicaid
OH0829689Medicaid
OH0829689Medicaid