Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 0101242967 | VA |
NPI | 1164534269 |
---|---|
Provider Name | Dr. Priya Jagannathan |
First Address | Fairfax, VA 22033-6407 |
Second Address | Springfield, VA 22150-1826 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 14/12/2021 |