Provider Demographics
NPI:1073671988
Name:WADDELL-JIGGETTS, BEVERLY (MD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:
Last Name:WADDELL-JIGGETTS
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:KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
Mailing Address - Street 2:2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNIT 6 W
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:14139 POTOMAC MILLS ROAD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4644
Practice Address - Country:US
Practice Address - Phone:703-490-8400
Practice Address - Fax:703-490-7701
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045183207V00000X
MDD0071877207V00000X
DCMD039469207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
160001888Medicare ID - Type Unspecified
E70481Medicare UPIN