Provider Demographics
NPI:1174583835
Name:JEFFRYES, VIRGINIA ANNE (MD)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ANNE
Last Name:JEFFRYES
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:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:FRANCONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03580-0577
Mailing Address - Country:US
Mailing Address - Phone:603-823-7234
Mailing Address - Fax:603-823-7234
Practice Address - Street 1:92 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:FRANCONIA
Practice Address - State:NH
Practice Address - Zip Code:03580-0577
Practice Address - Country:US
Practice Address - Phone:603-823-7234
Practice Address - Fax:603-823-7234
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11564207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30203289Medicaid
VTORE6829Medicaid
RE6829Medicare ID - Type Unspecified
H67201Medicare UPIN