Healthcare Provider Details

I. General information

NPI: 1801867536
Provider Name (Legal Business Name): JERALD R JARVI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE WHITE HOUSE MEDICAL UNIT
WASHINGTON DC
20502-0001
US

IV. Provider business mailing address

4588 CHRISTIANA PARRAN RD
CHESAPEAKE BEACH MD
20732-4040
US

V. Phone/Fax

Practice location:
  • Phone: 202-757-2476
  • Fax:
Mailing address:
  • Phone: 410-257-2965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101522
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: