MEDICARE: JERALD R JARVI PA-C

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	363A00000X	Physician Assistant	PA9101522	FL

General Provider Information

NPI Number	:	1801867536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERALD R JARVI PA-C

Provider Business Mailing Address
First Line	:	4588 CHRISTIANA PARRAN RD
Second Line	:
City	:	CHESAPEAKE BEACH
State	:	MD
Zip	:	20732-4040
Country	:	US
Telephone Number	:	410-257-2965
Fax Number	:

Provider Business Practice Location Address
First Line	:	THE WHITE HOUSE
Second Line	:	MEDICAL UNIT
City	:	WASHINGTON
State	:	DC
Zip	:	20502-0001
Country	:	US
Telephone Number	:	202-757-2476
Fax Number	:

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	07/08/2007

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