Healthcare Provider Details

I. General information

NPI: 1609899400
Provider Name (Legal Business Name): JEFFERSON MARK PRICHARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARTHA JEFFERSON DR
CHARLOTTESVILLE VA
22911
US

IV. Provider business mailing address

500 MARTHA JEFFERSON DR
CHARLOTTESVILLE VA
22911-4668
US

V. Phone/Fax

Practice location:
  • Phone: 434-654-8390
  • Fax: 434-654-8399
Mailing address:
  • Phone: 434-654-8390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0101232678
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: