Provider Demographics
NPI:1619932225
Name:MOSCOE, JAY EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:EDWARD
Last Name:MOSCOE
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:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:VA
Mailing Address - Zip Code:22727-0587
Mailing Address - Country:US
Mailing Address - Phone:540-948-6861
Mailing Address - Fax:
Practice Address - Street 1:125 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:VA
Practice Address - Zip Code:22727-3035
Practice Address - Country:US
Practice Address - Phone:540-948-6861
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
067495OtherANTHEM/BC/BS
VA5644399Medicaid
0800002891Medicare ID - Type Unspecified
VA5644399Medicaid