Jacob Theodoor Moll, M.D.

Primary specialty

Aerospace Medicine PhysicianTaxonomy code 2083A0100X

License

0101019920 Issued in VA

Practice address

723 Piney Forest Rd
Danville, VA 24540-2860

Phone

(434) 773-6830

Fax

(434) 773-6832

NPI assigned

Dec 20, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013071794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 COUNTRY PLACE RD",
            "city": "AXTON",
            "state": "VA",
            "postal_code": "240542566",
            "telephone_number": "276-666-5908",
            "fax_number": "276-666-5908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "723 PINEY FOREST RD",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245402860",
            "telephone_number": "434-773-6830",
            "fax_number": "434-773-6832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLL",
        "first_name": "JACOB",
        "middle_name": "THEODOOR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "VA",
            "license": "0101019920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Mitchell-Roberts, PSYD
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• Juliette Montauk-Moschler, PMHNP-BC
• Austin Lee Moon, DDS

• Aerospace Medicine Physician in Danville, VA
• Providers in Danville, VA by specialty
• Aerospace Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.