Provider Demographics
NPI:1710206818
Name:DEJESUS, JENNIFER (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:DEJESUS
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 1:7611 LITTLE RIVER TPKE STE 108
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2611
Mailing Address - Country:US
Mailing Address - Phone:703-717-7215
Mailing Address - Fax:703-717-7216
Practice Address - Street 1:7611 LITTLE RIVER TPKE STE 108
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2611
Practice Address - Country:US
Practice Address - Phone:703-717-7215
Practice Address - Fax:703-717-7216
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MAO9285100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program