Provider Demographics
NPI:1174799852
Name:NERIA, JENNIFER T (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:T
Last Name:NERIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 N GEORGE MASON DR
Mailing Address - Street 2:SUITE 434
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3683
Mailing Address - Country:US
Mailing Address - Phone:703-522-1860
Mailing Address - Fax:703-522-7293
Practice Address - Street 1:1625 N GEORGE MASON DR
Practice Address - Street 2:SUITE 434
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3683
Practice Address - Country:US
Practice Address - Phone:703-522-1860
Practice Address - Fax:703-522-7293
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
117479OtherMEDICARE