Provider Demographics
NPI:1821259771
Name:MOORE, JARED M (MD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:M
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-2594
Mailing Address - Fax:614-293-4487
Practice Address - Street 1:2050 KENNY RD STE 2400
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3502
Practice Address - Country:US
Practice Address - Phone:614-293-8054
Practice Address - Fax:614-293-4890
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2021-02-15
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Provider Licenses
StateLicense IDTaxonomies
OH35.094940207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3139571Medicaid
OH4320021Medicare PIN