Provider Demographics
NPI:1649385089
Name:JOSE, NORA DOCTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:NORA
Middle Name:DOCTOR
Last Name:JOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2616 SHERWOOD HALL LN
Mailing Address - Street 2:SUITE 404
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3100
Mailing Address - Country:US
Mailing Address - Phone:703-360-0300
Mailing Address - Fax:703-799-7074
Practice Address - Street 1:2616 SHERWOOD HALL LN
Practice Address - Street 2:SUITE 404
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3100
Practice Address - Country:US
Practice Address - Phone:703-360-0300
Practice Address - Fax:703-799-7074
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010226072080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA080748OtherANTHEM PIN
VA283727OtherAMERIGROUP PIN
VA283727OtherAMERIGROUP PIN