Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 0101238962 | VA |
NPI | 1003998097 |
---|---|
Provider Name | Jennifer Kasirsky |
First Address | Manassas, VA 20110-4418 |
Second Address | Manassas, VA 20110-4418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G72970 | (02) |