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General NPI Number Information
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NPI Number | 1295727816
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Entity Type | Individual
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Provider Name | JAN PAUL FRUITERMAN MD
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Gender | Male
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 02/16/2010
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Provider Practice Location Address
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Address Line | 900 S WASHINGTON ST ST 300
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4020
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Country | US
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Telephone | 703-532-2500
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Fax | 703-237-1184
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Provider Business Mailing Address
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Address Line | 18318 FAIRWAY OAKS SQ
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City | LEESBURG
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State | VA
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Zip | 20176-8460
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Country | US
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Telephone | 571-243-8806
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Fax | 703-779-1795
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 0101029267
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License Number State | VA
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