Provider Demographics
NPI:1467635862
Name:RUGGIERO, JASON P (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:P
Last Name:RUGGIERO
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 1:190 CAMPUS BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2872
Mailing Address - Country:US
Mailing Address - Phone:540-722-3500
Mailing Address - Fax:540-722-3536
Practice Address - Street 1:190 CAMPUS BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2872
Practice Address - Country:US
Practice Address - Phone:540-722-3500
Practice Address - Fax:540-722-3536
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101253723207WX0107X
PAMD442256207W00000X
CACA105296207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1467635862Medicaid
VA1467635862Medicare PIN