Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 8043674471 | VA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | D0077856 | MD |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD041163 | DC |
NPI | 1023329802 |
---|---|
Provider Name | Dr. Jonathan Bernard Menezes |
First Address | Reston, VA 20190-5286 |
Second Address | Reston, VA 20190-5286 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2010 |
Last Update Date | 27/05/2021 |