Provider Demographics
NPI:1275532418
Name:GERMROTH, JERRY A (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:A
Last Name:GERMROTH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:220 CAMPUS BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2888
Mailing Address - Country:US
Mailing Address - Phone:540-678-3588
Mailing Address - Fax:540-678-9025
Practice Address - Street 1:759 S MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1127
Practice Address - Country:US
Practice Address - Phone:540-459-1540
Practice Address - Fax:540-459-1486
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2019-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101034309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006015808Medicaid
VA012268OtherBCBS
VAB05949Medicare UPIN
VA110000093Medicare PIN