MEDICARE: JAIME PADAVIL MOSKOWITZ MD

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	207R00000X	Internal Medicine Physician	52063	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	925378	OTHER	CT	WELLCARE
2	010052063CT1	OTHER	CT	ANTHEM BCBS CT
3	2508638	OTHER	CT	COVENTRY/FIRST HEALTH
4	4914202	OTHER	CT	AETNA
5	052063	OTHER	CT	CONNECTICARE
6	1186645	OTHER	CT	USA

General Provider Information

NPI Number	:	1639499759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME PADAVIL MOSKOWITZ MD

Provider Business Mailing Address
First Line	:	406 FARMINGTON AVE
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06032-1964
Country	:	US
Telephone Number	:	860-676-7815
Fax Number	:

Provider Business Practice Location Address
First Line	:	406 FARMINGTON AVE
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06032-1964
Country	:	US
Telephone Number	:	860-676-7815
Fax Number	:

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

Provider Enumeration Date	:	06/11/2010
Last Update Date	:	01/20/2015

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