Provider Demographics
NPI:1427027010
Name:OSWALD, JAY R (PA)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:R
Last Name:OSWALD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-1935
Mailing Address - Country:US
Mailing Address - Phone:252-823-7288
Mailing Address - Fax:
Practice Address - Street 1:101 CLINIC DR
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-1935
Practice Address - Country:US
Practice Address - Phone:252-823-7288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103006363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2757067CMedicare PIN
S80807Medicare UPIN