Provider Demographics
NPI:1346234101
Name:JEANES, NINA VANN (MD, PC)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:VANN
Last Name:JEANES
Suffix:
Gender:F
Credentials:MD, PC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10110 MOLECULAR DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-279-2779
Mailing Address - Fax:301-279-2767
Practice Address - Street 1:201 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877
Practice Address - Country:US
Practice Address - Phone:301-216-4157
Practice Address - Fax:301-987-6297
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2012-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0012101207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB94114Medicare UPIN
MD174250Medicare PIN