MEDICARE: MARTHA JEFFERSON HOSPITAL

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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

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

General Provider Information

NPI Number	:	1912228628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTHA JEFFERSON HOSPITAL

Provider Business Mailing Address
First Line	:	590 PETER JEFFERSON PKWY STE 300
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22911-4628
Country	:	US
Telephone Number	:	434-654-8574
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 MARTHA JEFFERSON DR
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22911-4668
Country	:	US
Telephone Number	:	434-654-7042
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MELINDA SUMMERLIN HANCOCK
Credential	:
Telephone Number	:	757-455-7458

Provider Enumeration Date	:	06/16/2010
Last Update Date	:	12/11/2025

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