MEDICARE: DEKA A JAMA, M.D., LLC

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
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1689990608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEKA A JAMA, M.D., LLC

Provider Business Mailing Address
First Line	:	1934 OLD GALLOWS RD
Second Line	:	SUITE 350
City	:	VIENNA
State	:	VA
Zip	:	22182-4042
Country	:	US
Telephone Number	:	703-405-6852
Fax Number	:	703-752-6201

Provider Business Practice Location Address
First Line	:	1934 OLD GALLOWS RD
Second Line	:	SUITE 350
City	:	VIENNA
State	:	VA
Zip	:	22182-4042
Country	:	US
Telephone Number	:	703-405-6852
Fax Number	:	703-752-6201

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DEKA A JAMA
Credential	:	M.D.
Telephone Number	:	703-405-6852

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	04/15/2010

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