Healthcare Provider Details

I. General information

NPI: 1194750414
Provider Name (Legal Business Name): JEFFREY A WELGOSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3289 WOODBURN RD SUITE 130
ANNANDALE VA
22003-6800
US

IV. Provider business mailing address

3289 WOODBURN RD SUITE 130
ANNANDALE VA
22003-6800
US

V. Phone/Fax

Practice location:
  • Phone: 571-389-7140
  • Fax: 703-992-7584
Mailing address:
  • Phone: 571-389-7140
  • Fax: 703-992-7584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101057812
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101057812
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number0101057812
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: