Provider Demographics
NPI:1174940449
Name:DHARIA, JUGAL (DPM)
Entity type:Individual
Prefix:DR
First Name:JUGAL
Middle Name:
Last Name:DHARIA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10721 MAIN ST
Mailing Address - Street 2:SUITE #3500
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-352-8888
Mailing Address - Fax:703-352-8994
Practice Address - Street 1:10721 MAIN ST STE 3500
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6909
Practice Address - Country:US
Practice Address - Phone:703-352-8888
Practice Address - Fax:703-352-8994
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301208213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery