Provider Demographics
NPI:1639175391
Name:BYRD, JESSICA PANTEHA ABEDI (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:PANTEHA ABEDI
Last Name:BYRD
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2896
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:611 E JUBAL EARLY DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-5178
Practice Address - Country:US
Practice Address - Phone:540-536-5500
Practice Address - Fax:540-536-5507
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2022-06-14
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Provider Licenses
StateLicense IDTaxonomies
VA0101057879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005645948Medicaid
VAH33269Medicare UPIN
VA005645948Medicaid