Provider Demographics
NPI:1215921762
Name:JONES, SAMUEL MOSELEY (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:MOSELEY
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:950N GLEBE RD 4000
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1824
Mailing Address - Country:US
Mailing Address - Phone:571-295-7514
Mailing Address - Fax:
Practice Address - Street 1:3650 JOSEPH SIEWICK DR
Practice Address - Street 2:STE 400
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1710
Practice Address - Country:US
Practice Address - Phone:703-391-2020
Practice Address - Fax:703-391-1211
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101039402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA05624606Medicaid
VA080183206OtherRR MEDICARE
VA080183206OtherRR MEDICARE
VA05624606Medicaid