Healthcare Provider Details

I. General information

NPI: 1740538347
Provider Name (Legal Business Name): JENNIFER L RAZAK MGC, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER L WEISS

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9715 MEDICAL CENTER DR STE 315
ROCKVILLE MD
20850-6326
US

IV. Provider business mailing address

7968 HIDDEN BRIDGE DR
SPRINGFIELD VA
22153-3208
US

V. Phone/Fax

Practice location:
  • Phone: 301-681-6772
  • Fax: 301-681-2618
Mailing address:
  • Phone: 610-608-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberG0000038
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number013900025
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: