Provider Demographics
NPI:1548232887
Name:JENNETTE, DAVID BARRY (CSA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BARRY
Last Name:JENNETTE
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1509 SLEEPY LAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23433-1207
Mailing Address - Country:US
Mailing Address - Phone:757-238-9632
Mailing Address - Fax:
Practice Address - Street 1:1775 EYE ST NW
Practice Address - Street 2:SUITE 1150
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-2402
Practice Address - Country:US
Practice Address - Phone:202-870-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical