Provider Demographics
NPI:1982652707
Name:MUSMAND, JONATHAN JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JAY
Last Name:MUSMAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:195 FORE RIVER PKWY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-774-9839
Mailing Address - Fax:207-761-2127
Practice Address - Street 1:195 FORE RIVER PKWY
Practice Address - Street 2:SUITE 410
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2780
Practice Address - Country:US
Practice Address - Phone:207-774-9839
Practice Address - Fax:207-761-2127
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013825174400000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME110740000Medicaid
MEF44209Medicare UPIN
MEMM5522Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE