Provider Demographics
NPI:1679232375
Name:JERGO, DION JAMES SR (CFT, SSN, SET)
Entity Type:Individual
Prefix:MR
First Name:DION
Middle Name:JAMES
Last Name:JERGO
Suffix:SR
Gender:M
Credentials:CFT, SSN, SET
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 BRECKINRIDGE SQUARE SE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-8968
Mailing Address - Country:US
Mailing Address - Phone:540-454-1868
Mailing Address - Fax:
Practice Address - Street 1:523 BRECKINRIDGE SQUARE SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-8968
Practice Address - Country:US
Practice Address - Phone:540-454-1868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA