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NPI Code Detail

MEDICARE: JEFFREY A JACKMAN MD

MEDICARE: JEFFREY A JACKMAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0000XCardiovascular Disease Physician0101058984VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00302186OTHERDCRAILROAD MEDICARE DC #

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437111622
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY A JACKMAN MD
Provider Business Mailing Address
First Line : 2901 TELESTAR CT STE 300
Second Line :
City : FALLS CHURCH
State : VA
Zip : 22042-1263
Country : US
Telephone Number : 703-591-1688
Fax Number : 703-591-1445
Provider Business Practice Location Address
First Line : 4825 MARK CENTER DR STE 150
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22311-1846
Country : US
Telephone Number : 703-751-8111
Fax Number : 703-751-1105
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2006
Last Update Date : 08/25/2022

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Directions to “ JEFFREY A JACKMAN MD” Practice Location

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