Provider Demographics
NPI:1598716425
Name:KING, JACQUELINE N (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:N
Last Name:KING
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 1:8204 COLLINGWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308-1600
Mailing Address - Country:US
Mailing Address - Phone:301-455-9203
Mailing Address - Fax:
Practice Address - Street 1:6020 RICHMOND HWY STE 102
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22303-2157
Practice Address - Country:US
Practice Address - Phone:571-308-6776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU7703207Q00000X
VA0101233619207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine