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Individual

DR. JEFFERSON EADDY CARTER MOULDS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
20480 MARKET STREET, ONANCOCK, VA 23417-0430
(757) 302-2600
(757) 789-0631
Mailing address
PO BOX 430, ONANCOCK, VA 23417-0430
(757) 302-2600
(757) 789-0631

Taxonomy

Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
0101052934
VA
2085R0001X
Radiation Oncology Physician
21925
DC
2085R0001X
Radiation Oncology Physician
D50244
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1265420582
VA
01
2176156
MAMSI/UNITED HEALTHCARE
VA
01
342750
ANTHEM BCBS
VA
01
9558847
CIGNA
VA
Enumeration date
10/11/2005
Last updated
07/21/2022
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