Provider Demographics
NPI:1184635880
Name:MOEN, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:MOEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1068 NATIONAL HIGHWAY REAR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7501
Mailing Address - Country:US
Mailing Address - Phone:301-729-8380
Mailing Address - Fax:301-729-0245
Practice Address - Street 1:1068 NATIONAL HIGHWAY REAR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-7501
Practice Address - Country:US
Practice Address - Phone:301-729-8380
Practice Address - Fax:301-729-0245
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0033417207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D44283Medicare UPIN