Provider Demographics
NPI:1417930538
Name:JENET, RICHARD N (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:N
Last Name:JENET
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 1:2296 OPITZ BLVD
Mailing Address - Street 2:#440
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3300
Mailing Address - Country:US
Mailing Address - Phone:703-878-0740
Mailing Address - Fax:703-878-3933
Practice Address - Street 1:2296 OPITZ BLVD
Practice Address - Street 2:#440
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3300
Practice Address - Country:US
Practice Address - Phone:703-878-0740
Practice Address - Fax:703-878-3933
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038636174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006201601Medicaid
160000769Medicare ID - Type Unspecified
VA006201601Medicaid