| Jacob T Joseph Md Pc | |
|
10721 Main St Suite 1100 Fairfax VA 22030-6914 | |
| (703) 273-4762 | |
| (703) 591-7719 |
| Full Name | Jacob T Joseph Md Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 10721 Main St, Fairfax, Virginia |
| Authorized Official Name and Position | Jacob T Joseph (PRESIDENT) |
| Authorized Official Contact | 7032734762 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacob T Joseph Md Pc 10721 Main St Suite 1100 Fairfax VA 22030-6914 Ph: (703) 273-4762 | Jacob T Joseph Md Pc 10721 Main St Suite 1100 Fairfax VA 22030-6914 Ph: (703) 273-4762 |
| NPI Number | 1457472391 |
|---|---|
| Provider Enumeration Date | 04/02/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 8820041965 |
|---|---|
| Medicare Enrollment ID | O20050301000262 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457472391 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | 0101034461 (Virginia) | Primary |
| Provider Name | Jacob T Joseph |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346332939 PECOS PAC ID: 1951354091 Enrollment ID: I20120426000493 |
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