Healthcare Provider Details

I. General information

NPI: 1558882860
Provider Name (Legal Business Name): JEFFREY JASON KATRA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 BERKMAR CIR
CHARLOTTESVILLE VA
22901-1464
US

IV. Provider business mailing address

115 WITTON CT APT 9
CHARLOTTESVILLE VA
22903-6414
US

V. Phone/Fax

Practice location:
  • Phone: 434-400-9668
  • Fax:
Mailing address:
  • Phone: 570-690-4186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS019982
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number0102206429
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: