Provider Demographics
NPI:1255328415
Name:DOMER, JENNIFER HOLLAR (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:HOLLAR
Last Name:DOMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7023 OLD JAHNKE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4126
Mailing Address - Country:US
Mailing Address - Phone:804-320-1353
Mailing Address - Fax:804-320-6636
Practice Address - Street 1:7023 OLD JAHNKE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4126
Practice Address - Country:US
Practice Address - Phone:804-320-1353
Practice Address - Fax:804-320-6636
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA57091208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA011092OtherCIGNA
VA2239604OtherAETNA
VA54-1549651OtherPCR
VA54-1549651OtherPHCS
VA6731201Medicaid
VA1201718OtherUNITED HEALTHCARE
VA265470OtherANTHEM
VA873734OtherMAMSI
VA1732397OtherFIRST HEALTH
VA122251OtherSOUTHERN HEALTH