Provider Demographics
NPI:1639499759
Name:MOSKOWITZ, JAIME PADAVIL (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:PADAVIL
Last Name:MOSKOWITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1964
Mailing Address - Country:US
Mailing Address - Phone:860-676-7815
Mailing Address - Fax:
Practice Address - Street 1:406 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1964
Practice Address - Country:US
Practice Address - Phone:860-676-7815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT52063207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT925378OtherWELLCARE
CT010052063CT1OtherANTHEM BCBS CT
CT2508638OtherCOVENTRY/FIRST HEALTH
CT4914202OtherAETNA
CT052063OtherCONNECTICARE
CT1186645OtherUSA
CT4914202OtherAETNA