Healthcare Provider Details

I. General information

NPI: 1760445613
Provider Name (Legal Business Name): GEORGE JEFFREY CEREMUGA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP
FT BELVOIR VA
22060-5285
US

IV. Provider business mailing address

9300 DEWITT LOOP
FT BELVOIR VA
22060-5285
US

V. Phone/Fax

Practice location:
  • Phone: 571-326-4446
  • Fax: 571-231-2387
Mailing address:
  • Phone: 571-326-4446
  • Fax: 571-231-2387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number10889
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: