Healthcare Provider Details

I. General information

NPI: 1831176080
Provider Name (Legal Business Name): JAIME ESCANELLAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 BEAM LN STE 205
FISHERSVILLE VA
22939-2350
US

IV. Provider business mailing address

PO BOX 9007
CHARLOTTESVILLE VA
22906-9007
US

V. Phone/Fax

Practice location:
  • Phone: 434-243-7121
  • Fax: 434-243-7122
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101050866
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: