Healthcare Provider Details

I. General information

NPI: 1659697126
Provider Name (Legal Business Name): JERITA JOHANNA DUBASH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 UNIVERSITY CITY BLVD
BLACKSBURG VA
24060-2706
US

IV. Provider business mailing address

700 UNIVERSITY CITY BLVD
BLACKSBURG VA
24060-2706
US

V. Phone/Fax

Practice location:
  • Phone: 540-961-8300
  • Fax: 540-961-8465
Mailing address:
  • Phone: 540-855-1332
  • Fax: 540-322-1840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0102203899
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: