Healthcare Provider Details

I. General information

NPI: 1851390660
Provider Name (Legal Business Name): JENNIFER M RAGI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 11/27/2023
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11844 ROCK LANDING DR SUITE B
NEWPORT NEWS VA
23606
US

IV. Provider business mailing address

11844 ROCK LANDING DR SUITE B
NEWPORT NEWS VA
23606-4206
US

V. Phone/Fax

Practice location:
  • Phone: 757-873-0161
  • Fax: 757-873-0205
Mailing address:
  • Phone: 757-873-0161
  • Fax: 757-873-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101251750
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101251750
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: