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General NPI Number Information
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NPI Number | 1679625248
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Entity Type | Organization
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Legal Business Name | P JEAN DREW MD PLC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 12/20/2007
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Provider Practice Location Address
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Address Line | 9683 A MAIN STREET WOODSON SQUARE
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City | FAIRFAX
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State | VA
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Zip | 22031-3755
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Country | US
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Telephone | 703-426-4900
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Fax | 703-426-4955
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Provider Business Mailing Address
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Address Line | 9683 A MAIN STREET WOODSON SQUARE
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City | FAIRFAX
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State | VA
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Zip | 22031-3755
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Country | US
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Telephone | 703-426-4900
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Fax | 703-426-4955
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | P JEAN DREW
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Credential | MD
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Telephone | 703-426-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101046952
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License Number State | VA
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