Healthcare Provider Details

I. General information

NPI: 1871931675
Provider Name (Legal Business Name): DR. JACLYN M FLEMING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACLYN M SAGGESE D.O.

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3307
US

V. Phone/Fax

Practice location:
  • Phone: 703-920-0896
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116026139
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: