Healthcare Provider Details

I. General information

NPI: 1952390858
Provider Name (Legal Business Name): JENNIFER A CARDONE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13855 COURTHOUSE RD
DINWIDDIE VA
23841-2254
US

IV. Provider business mailing address

13855 COURTHOUSE RD
DINWIDDIE VA
23841-2254
US

V. Phone/Fax

Practice location:
  • Phone: 804-469-3731
  • Fax: 804-469-5307
Mailing address:
  • Phone: 804-469-3731
  • Fax: 804-320-6636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101055260
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: