Provider Demographics
NPI:1265417216
Name:MOLDOVAN, JEFFREY M (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:MOLDOVAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 DARROW RD
Mailing Address - Street 2:STE 106
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5026
Mailing Address - Country:US
Mailing Address - Phone:330-656-5911
Mailing Address - Fax:330-656-5901
Practice Address - Street 1:667 EASTLAND AVE SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4503
Practice Address - Country:US
Practice Address - Phone:330-841-4000
Practice Address - Fax:330-841-4007
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005203207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000383091OtherANTHEM
OH0856328Medicaid
OH000000028430OtherANTHEM
OH001272239-0014OtherPENNSYLVANIA MEDICAID
OH000000383091OtherANTHEM
F13275Medicare UPIN
OH000000028430OtherANTHEM
OHMO0840271Medicare PIN