Healthcare Provider Details

I. General information

NPI: 1386661262
Provider Name (Legal Business Name): JODI ROBIN NATOVITZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3914 CENTREVILLE RD STE 225
CHANTILLY VA
20151-3045
US

IV. Provider business mailing address

5341 CRIMSON SKY CT
CENTREVILLE VA
20120-3004
US

V. Phone/Fax

Practice location:
  • Phone: 703-956-6301
  • Fax: 855-308-2338
Mailing address:
  • Phone: 703-830-1739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101053539
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: