Provider Demographics
NPI:1619964392
Name:MORAY, JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:MORAY
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 1:354 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1754
Mailing Address - Country:US
Mailing Address - Phone:978-687-2321
Mailing Address - Fax:978-722-7287
Practice Address - Street 1:10 GEORGE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-2293
Practice Address - Country:US
Practice Address - Phone:978-687-2321
Practice Address - Fax:978-722-7287
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH82852084N0400X
MA579102084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA05-81121OtherEVERCARE
MA0926611-001OtherCIGNA
MA23594OtherFCHP
MA3052389Medicaid
MAJ08646OtherBCBS
MA3002621OtherNHP
MA713936OtherTHP
NH0104025Y0MA01OtherANTHEM
MA05-00030OtherUHC
MA12400OtherHPHC
NH30003390Medicaid
MA4337469OtherAETNA
MA713936OtherTHP
NH30003390Medicaid
MA0926611-001OtherCIGNA