Healthcare Provider Details

I. General information

NPI: 1619923356
Provider Name (Legal Business Name): JEROME FRANK FOER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2197
US

IV. Provider business mailing address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2197
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-9519
  • Fax:
Mailing address:
  • Phone: 757-953-9519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0810000292
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: