Provider Demographics
NPI:1265758858
Name:NINA VANN JEANES M.D., P.C.
Entity type:Organization
Organization Name:NINA VANN JEANES M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:VANN
Authorized Official - Last Name:JEANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-670-1873
Mailing Address - Street 1:19221 MONTGOMERY VILLAGE AVENUE
Mailing Address - Street 2:C-20
Mailing Address - City:MONTGOMERY COUNTY
Mailing Address - State:MD
Mailing Address - Zip Code:20886
Mailing Address - Country:US
Mailing Address - Phone:301-670-1873
Mailing Address - Fax:301-670-1640
Practice Address - Street 1:19221 MONTGOMERY VILLAGE AVENUE
Practice Address - Street 2:C-20
Practice Address - City:MONTGOMERY COUNTY
Practice Address - State:MD
Practice Address - Zip Code:20886
Practice Address - Country:US
Practice Address - Phone:301-670-1873
Practice Address - Fax:301-670-1640
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NINA VANN JEANES M.D., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0012101207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD174250Medicare UPIN