Healthcare Provider Details

I. General information

NPI: 1932306479
Provider Name (Legal Business Name): JESSICA PARTIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RIVERSIDE CIR
ROANOKE VA
24016-4955
US

IV. Provider business mailing address

3 RIVERSIDE CIR
ROANOKE VA
24016-4955
US

V. Phone/Fax

Practice location:
  • Phone: 540-224-5170
  • Fax: 540-983-8212
Mailing address:
  • Phone: 540-224-5170
  • Fax: 540-983-8212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35-095761
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number22574
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101261647
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: