MEDICARE: DR. JEANNE M DENSMORE 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
1	207R00000X	Internal Medicine Physician	0101053711	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45315	OTHER	VA	COMMUNITY HEALTH
2	142771	OTHER	VA	SOUTHERN HEALTH
3	230700	OTHER	VA	ANTHEM SVC/HEALTHKEEPERS
4	700001548	OTHER	VA	CIGNA
5	267068	OTHER	VA	MAMSI

General Provider Information

NPI Number	:	1730127721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEANNE M DENSMORE MD

Provider Business Mailing Address
First Line	:	1562 INSURANCE LN
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22911-7229
Country	:	US
Telephone Number	:	434-293-5548
Fax Number	:	434-293-4664

Provider Business Practice Location Address
First Line	:	1562 INSURANCE LN
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22911-7229
Country	:	US
Telephone Number	:	434-293-5548
Fax Number	:	434-293-4664

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	01/04/2011

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Directions to “ DR. JEANNE M DENSMORE MD” Practice Location

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