Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 0101040079 | VA |
NPI | 1427244490 |
---|---|
Provider Name | Dr. Jessica Jane Radcliffe |
First Address | Midlothian, VA 23113-1396 |
Second Address | Richmond, VA 23226-1930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2007 |
Last Update Date | 22/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C06778 | GROUP PTAN (01) | VA |