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General NPI Number Information
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NPI Number | 1912113168
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Entity Type | Individual
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Provider Name | JENNIFER DELUCA OLDHAM MD
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 650 LAUREL ST
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City | CULPEPER
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State | VA
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Zip | 22701-3910
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Country | US
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Telephone | 540-825-5656
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Fax | 540-825-1612
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Provider Business Mailing Address
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Address Line | PO BOX 1568
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City | CULPEPER
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State | VA
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Zip | 22701-6568
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Country | US
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Telephone | 540-825-3100
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Fax | 540-829-5440
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101241257
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License Number State | VA
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