Healthcare Provider Details

I. General information

NPI: 1295727816
Provider Name (Legal Business Name): JAN PAUL FRUITERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S WASHINGTON ST ST 300
FALLS CHURCH VA
22046-4020
US

IV. Provider business mailing address

18318 FAIRWAY OAKS SQ
LEESBURG VA
20176-8460
US

V. Phone/Fax

Practice location:
  • Phone: 703-532-2500
  • Fax: 703-237-1184
Mailing address:
  • Phone: 571-243-8806
  • Fax: 703-779-1795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101029267
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: