MEDICARE: DR. JEFFERSON EADDY CARTER MOULDS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	D50244	MD
2	2085R0001X	Radiation Oncology Physician	21925	DC
3	2085R0001X	Radiation Oncology Physician	0101052934	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2176156	OTHER	VA	MAMSI/UNITED HEALTHCARE
3	342750	OTHER	VA	ANTHEM BCBS
4	9558847	OTHER	VA	CIGNA

General Provider Information

NPI Number	:	1265420582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERSON EADDY CARTER MOULDS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 430
Second Line	:
City	:	ONANCOCK
State	:	VA
Zip	:	23417-0430
Country	:	US
Telephone Number	:	757-302-2600
Fax Number	:	757-789-0631

Provider Business Practice Location Address
First Line	:	20480 MARKET STREET
Second Line	:
City	:	ONANCOCK
State	:	VA
Zip	:	23417-0430
Country	:	US
Telephone Number	:	757-302-2600
Fax Number	:	757-789-0631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	07/21/2022

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