Provider Demographics
NPI:1588802821
Name:JASPAL, PRAVEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAVEEN
Middle Name:
Last Name:JASPAL
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 1:20057 BOXWOOD PL
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5637
Mailing Address - Country:US
Mailing Address - Phone:703-724-4934
Mailing Address - Fax:
Practice Address - Street 1:1680 CAPITAL ONE DR
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3407
Practice Address - Country:US
Practice Address - Phone:703-720-1290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101245395207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine