Individual
JONATHAN S. MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
234 GOODMAN ST, CINCINNATI, OH 45219-2364
(513) 584-7355
(513) 584-0431
Mailing address
PO BOX 636256 CENTRAL CREDENTIALING, CINCINNATI, OH 45263-6256
(513) 245-3107
(513) 585-5511
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
35.051867
OH
2085R0202X
Diagnostic Radiology Physician
35-05-1867-M
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000014486
ANTHEM
OH
05
—
0626675
—
OH
01
—
1620980
UHC
OH
05
—
200039000A
—
IN
01
—
300033840
RAILROAD MEDICARE
OH
05
—
300289600
—
WV
05
—
64787112
—
KY
01
—
655268
AETNA
OH
05
—
Q51867
—
SC
Enumeration date
06/07/2006
Last updated
02/20/2018
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