Provider Demographics
NPI:1386661262
Name:NATOVITZ, JODI ROBIN (MD)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:ROBIN
Last Name:NATOVITZ
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 1:5341 CRIMSON SKY CT
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-3004
Mailing Address - Country:US
Mailing Address - Phone:703-830-1739
Mailing Address - Fax:
Practice Address - Street 1:3914 CENTREVILLE RD STE 225
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-3045
Practice Address - Country:US
Practice Address - Phone:703-956-6301
Practice Address - Fax:855-308-2338
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053539208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG22223Medicare UPIN