Provider Demographics
NPI:1265513238
Name:CONKLIN, JEFFREY B (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
Last Name:CONKLIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:21785 FILIGREE CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6213
Mailing Address - Country:US
Mailing Address - Phone:703-554-1100
Mailing Address - Fax:703-554-1110
Practice Address - Street 1:21785 FILIGREE CT
Practice Address - Street 2:SUITE 100
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6213
Practice Address - Country:US
Practice Address - Phone:703-554-1100
Practice Address - Fax:703-554-1110
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2011-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101248660207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1265513238Medicaid