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General NPI Number Information
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NPI Number | 1194889543
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Entity Type | Individual
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Provider Name | JAMES RITCHIE JEZIOR M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 06/06/2021
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Provider Practice Location Address
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Address Line | 12255 FAIR LAKES PKWY BLDG 4TH
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City | FAIRFAX
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State | VA
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Zip | 22033-3952
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Country | US
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Telephone | 703-934-4120
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Fax |
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Provider Business Mailing Address
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Address Line | 12041 CREEKBEND DR
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City | RESTON
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State | VA
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Zip | 20194-5629
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Country | US
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Telephone | 240-447-0428
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 0101059361
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License Number State | VA
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