Provider Demographics
NPI:1689755357
Name:KATZEN, JAY E (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:E
Last Name:KATZEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 D CORNWALL STREET NW
Mailing Address - Street 2:STE 403
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:1901 N BEAUREGARD STREET, SUITE 100
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1721
Practice Address - Country:US
Practice Address - Phone:703-931-9100
Practice Address - Fax:703-931-3415
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027407207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1689755357Medicaid
VA30016739150001Medicaid
VA1800032892Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MD8956502-02Medicaid
MD8956502-03Medicaid
VA000C43N63Medicare ID - Type UnspecifiedTRAILBLAZERS NVA, DEL, MD
VA180000751Medicare ID - Type UnspecifiedTRAILBLAZERS CENTRAL VA
VA6305229Medicaid
VA6305202Medicaid
VA107426OtherANTHEM BCBS/HEALTHKEEPERS
VA107427OtherANTHEM BCBS/HEALTHKEEPERS
VA107428OtherANTHEM BCBS/HEALTHKEEPERS
VA262643OtherANTHEM BCBS/HEALTHKEEPERS
VA6305211Medicaid
VAB94515Medicare UPIN
MD8956502-00Medicaid
WV9639000Medicaid
MD8956502-01Medicaid