Provider Demographics
NPI:1497169908
Name:JACQUES, LINA (MD)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:JACQUES
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 1:418 GRAND PARK DR STE 321
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26105-4000
Mailing Address - Country:US
Mailing Address - Phone:304-865-5190
Mailing Address - Fax:304-865-5569
Practice Address - Street 1:418 GRAND PARK DR STE 321
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26105-4000
Practice Address - Country:US
Practice Address - Phone:304-865-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.143941207R00000X
TXR4402207R00000X
WV27083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine