Provider Demographics
NPI:1245219716
Name:BLAKE, JENNIFER CHERPES (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CHERPES
Last Name:BLAKE
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 1:5765 BURKE CENTRE PKWY
Mailing Address - Street 2:#124
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2264
Mailing Address - Country:US
Mailing Address - Phone:703-784-1630
Mailing Address - Fax:
Practice Address - Street 1:3259 CATLIN AVE
Practice Address - Street 2:MILITARY MEDICINE
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134-5109
Practice Address - Country:US
Practice Address - Phone:703-784-1630
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine