Provider Demographics
NPI:1942439740
Name:MOELLER, JEREMY JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:JAMES
Last Name:MOELLER
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 1:400 COLUMBUS AVE
Mailing Address - Street 2:CREDENTIALING SPECIALIST
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1233
Mailing Address - Country:CA
Mailing Address - Phone:203-503-3174
Mailing Address - Fax:203-503-6515
Practice Address - Street 1:SUITE 504, 44-46 PORTLAND STREET
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:NOVA SCOTIA
Practice Address - Zip Code:B2Y 1H4
Practice Address - Country:CA
Practice Address - Phone:902-420-1878
Practice Address - Fax:902-420-1623
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0515862084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology