Physician Compare National (NPI:1174940449)

HEALTHCARE PROVIDER: JUGAL DHARIA DPM

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1174940449
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5890068266
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170906002908
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DHARIA
	Individual professional last name
Provider First Name	JUGAL
	Individual professional first name
Provider Middle Name	RAKESH
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	TEMPLE UNIVERSITY SCHOOL OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	2014
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	STEVEN R VETTER
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	7911025044
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	10721 MAIN ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 3500
	Group Practice or individual's line 2 address
City	FAIRFAX
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	220306909
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7033528888
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	490063
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	INOVA FAIRFAX HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y