Healthcare Provider Details

I. General information

NPI: 1134812100
Provider Name (Legal Business Name): SRIMATHY JAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MATTIE JAIN MD, MS

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 JEFFERSON PARK AVE
CHARLOTTESVILLE VA
22908-0005
US

IV. Provider business mailing address

PO BOX 749112
ATLANTA GA
30374-9112
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-5485
  • Fax:
Mailing address:
  • Phone: 434-295-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101286788
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number0101286788
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: