Healthcare Provider Details

I. General information

NPI: 1093335697
Provider Name (Legal Business Name): JACOB E TRUMBUL I PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 WOODBERRY LN APT 119
WINCHESTER VA
22601-3592
US

IV. Provider business mailing address

21475 RIDGETOP CIR STE 150
STERLING VA
20166-6580
US

V. Phone/Fax

Practice location:
  • Phone: 703-987-0233
  • Fax:
Mailing address:
  • Phone: 703-444-5000
  • Fax: 703-444-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: