Provider Demographics
NPI:1295725042
Name:JAY, MICHAEL E (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:JAY
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 1:111 BREWSTER STREET
Mailing Address - Street 2:WOOD BLDG #516
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4474
Mailing Address - Country:US
Mailing Address - Phone:401-729-3481
Mailing Address - Fax:401-729-2721
Practice Address - Street 1:111 BREWSTER STREET
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4474
Practice Address - Country:US
Practice Address - Phone:401-729-2339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA491662085R0204X
RIMD123062085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA049166OtherTUFTS HEALTH PLAN
MA344539OtherHARVARD PILGRIM
MAJ25694OtherBCBS RI
MA0188433Medicaid
MA30013557OtherRAILROAD MEDICARE
MA04-3140277OtherHCVM FIRST HEALTH
MA04-3140277OtherTRICARE
MA16-00012OtherUNITED HEALTHCARE MA
MA410511OtherBLUE CHIP R
MA4642867002OtherCIGNA MA
MAJ25694OtherBMA
MA000000028363OtherHEALTH NET
MAA34787Medicare ID - Type Unspecified
MA000000028363OtherHEALTH NET