Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0102204221 | VA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 0102204221 | VA |
NPI | 1114273463 |
---|---|
Provider Name | Dr. Jessica M. Tsukanov |
First Address | Richmond, VA 23291-1734 |
Second Address | Richmond, VA 23298-5051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2012 |
Last Update Date | 22/09/2015 |