Healthcare Provider Details

I. General information

NPI: 1225452303
Provider Name (Legal Business Name): MARTHA JEFFERSON HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 MARTHA JEFFERSON DR SUITE 290
CHARLOTTESVILLE VA
22911-4669
US

IV. Provider business mailing address

500 MARTHA JEFFERSON DR
CHARLOTTESVILLE VA
22911-4668
US

V. Phone/Fax

Practice location:
  • Phone: 434-654-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELINDA SUMMERLIN HANCOCK
Title or Position: CFO
Credential:
Phone: 757-455-7458