Healthcare Provider Details

I. General information

NPI: 1548427271
Provider Name (Legal Business Name): JENNIFER BROWN O'NEIL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNN BROWN MD

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 WILLOW OAKS CORPORATE DR STE 400
FAIRFAX VA
22031-4513
US

IV. Provider business mailing address

2121 N WESTMORELAND ST APT 343
ARLINGTON VA
22213-1055
US

V. Phone/Fax

Practice location:
  • Phone: 703-573-0504
  • Fax: 703-573-4856
Mailing address:
  • Phone: 814-883-7725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101250398
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number061047
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number0101250398
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: