Provider Demographics
NPI:1003194218
Name:SIDDON, JONATHAN L (DO)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:L
Last Name:SIDDON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7051 HEATHCOTE VILLAGE WAY STE 140
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3198
Mailing Address - Country:US
Mailing Address - Phone:571-685-4388
Mailing Address - Fax:703-743-5275
Practice Address - Street 1:7051 HEATHCOTE VILLAGE WAY STE 140
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3198
Practice Address - Country:US
Practice Address - Phone:571-685-4388
Practice Address - Fax:703-743-5275
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine