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General NPI Number Information
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NPI Number | 1386668903
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Entity Type | Individual
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Provider Name | ANNAMMA J JACOB M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 1635 N GEORGE MASON DR STE 240
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City | ARLINGTON
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State | VA
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Zip | 22205-3681
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Country | US
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Telephone | 703-528-1329
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Fax | 703-522-4915
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Provider Business Mailing Address
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Address Line | 1635 N GEORGE MASON DR STE 240
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City | ARLINGTON
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State | VA
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Zip | 22205-3681
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Country | US
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Telephone | 703-528-1329
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Fax | 703-522-4915
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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 | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | 0101034078
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 0101034078
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License Number State | VA
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