=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700998630
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY HUNT SEDGEWICK MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 08/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44121 HARRY BYRD HWY SUITE 175
-----------------------------------------------------
City | ASHBURN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20147-5667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-723-1981
-----------------------------------------------------
Fax | 703-723-3937
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7008 CHURCHILL RD
-----------------------------------------------------
City | MC LEAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22101-2608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-723-1981
-----------------------------------------------------
Fax | 703-723-3937
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 0101225326
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------