Provider Demographics
NPI:1275562589
Name:CARMOUCHE, JONATHAN J (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:J
Last Name:CARMOUCHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2331 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1111
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-240988207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1275562589OtherHEALTHKEEPERS PLUS
VA1275562589OtherVIRGINIA HEALTH NETWORK
VA3810018726OtherMEDICAID OF WEST VIRGINIA
VA1275562589OtherINTOTAL
VA1275562589OtherCIGNA
VA1275562589OtherAETNA
VA1275562589OtherOPTIMA HEALTH PLAN
VA1275562589OtherUMWA
VA1275562589OtherVA PREMIER
VA1275562589OtherANTHEM
VA1275562589Medicaid
VAP00834687OtherRAILROAD MEDICARE
VA1275562589OtherHUMANA MEDICARE
VA1275562589OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1275562589OtherUNITED HEALTHCARE
VA371194700OtherBLACK LUNG
VA1275562589OtherHEALTHKEEPERS
VA540506332108OtherTRICARE/CHAMPUS
VA1275562589OtherGATEWAY
VA1275562589OtherUNITED HEALTHCARE
I62483Medicare UPIN
VA022973C19Medicare PIN