Provider Demographics
NPI:1790751428
Name:NELSON, JANE E (MD)
Entity Type:Individual
Prefix:MISS
First Name:JANE
Middle Name:E
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3111 TELEGRAPH CORNER LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2359
Mailing Address - Country:US
Mailing Address - Phone:703-317-3200
Mailing Address - Fax:703-317-3231
Practice Address - Street 1:3111 TELEGRAPH CORNER LN
Practice Address - Street 2:SUITE 100
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2359
Practice Address - Country:US
Practice Address - Phone:703-317-3200
Practice Address - Fax:703-317-3231
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101039741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A521A55Medicare ID - Type Unspecified
C88377Medicare UPIN