Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 0102203729 | VA |
Y | 111NI0900X | Internist | 0102203729 | VA |
NPI | 1003194218 |
---|---|
Provider Name | Dr. Jonathan L Siddon |
First Address | Gainesville, VA 20155-3198 |
Second Address | Gainesville, VA 20155-3198 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2011 |
Last Update Date | 12/04/2021 |