{
"Npi": {
"NPI": "1679625248",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "P JEAN DREW MD PLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "9683 A MAIN STREET",
"SecondLineMailingAddress": "WOODSON SQUARE",
"MailingAddressCityName": "FAIRFAX",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22031-3755",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-426-4900",
"MailingAddressFaxNumber": "703-426-4955",
"FirstLinePracticeLocationAddress": "9683 A MAIN STREET",
"SecondLinePracticeLocationAddress": "WOODSON SQUARE",
"PracticeLocationAddressCityName": "FAIRFAX",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22031-3755",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "703-426-4900",
"PracticeLocationAddressFaxNumber": "703-426-4955",
"EnumerationDate": "01/17/2007",
"LastUpdateDate": "12/20/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DREW",
"AuthorizedOfficialFirstName": "P",
"AuthorizedOfficialMiddleName": "JEAN",
"AuthorizedOfficialTitle": "PHYSICIAN OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "703-426-4900",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "0101046952",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}