Provider Demographics
NPI:1659423911
Name:JARA, JESSICA MARITZA (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARITZA
Last Name:JARA
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 1:2010 ATHERHOLT RD
Mailing Address - Street 2:UNIT G
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2410 ATHERHOLT RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2148
Practice Address - Country:US
Practice Address - Phone:434-200-5252
Practice Address - Fax:407-400-7966
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0094325207RC0000X
VA0101246117207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1659423911Medicaid
VA1659423911Medicaid
VAP00779069Medicare PIN
VA022015L84Medicare PIN
P01434614Medicare PIN