Provider Demographics
NPI:1558882860
Name:KATRA, JEFFREY JASON (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JASON
Last Name:KATRA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 WITTON CT APT 9
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-6414
Mailing Address - Country:US
Mailing Address - Phone:570-690-4186
Mailing Address - Fax:
Practice Address - Street 1:631 BERKMAR CIR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1464
Practice Address - Country:US
Practice Address - Phone:434-400-9668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS019982207Q00000X
VA0102206429207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine