Healthcare Provider Details

I. General information

NPI: 1053548917
Provider Name (Legal Business Name): JENNIFER BAGDADY DAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ANN BAGDADY M.D.

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8136 OLD KEENE MILL RD STE B300
SPRINGFIELD VA
22152-1856
US

IV. Provider business mailing address

8136 OLD KEENE MILL RD STE B300
SPRINGFIELD VA
22152-1856
US

V. Phone/Fax

Practice location:
  • Phone: 703-451-6111
  • Fax: 703-451-6247
Mailing address:
  • Phone: 703-451-6111
  • Fax: 703-451-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number0101252410
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101252410
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: