Provider Demographics
NPI:1417251992
Name:MANN, JATINDER SINGH (MD)
Entity Type:Individual
Prefix:MR
First Name:JATINDER
Middle Name:SINGH
Last Name:MANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14527 JEFFERSON DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-2817
Mailing Address - Country:US
Mailing Address - Phone:703-497-1234
Mailing Address - Fax:703-499-9988
Practice Address - Street 1:14527 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-2817
Practice Address - Country:US
Practice Address - Phone:703-497-1234
Practice Address - Fax:703-499-9988
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040696207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB59994Medicare UPIN