Healthcare Provider Details

I. General information

NPI: 1467598458
Provider Name (Legal Business Name): JARED ADAM HERSHENSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 ARLINGTON BLVD SUITE 500
FAIRFAX VA
22031-5207
US

IV. Provider business mailing address

709 HORTON DR
SILVER SPRING MD
20902-3010
US

V. Phone/Fax

Practice location:
  • Phone: 703-876-8410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP19047
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number35090462
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number0101249560
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: