Provider Demographics
NPI:1801867536
Name:JARVI, JERALD R (PA-C)
Entity Type:Individual
Prefix:
First Name:JERALD
Middle Name:R
Last Name:JARVI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4588 CHRISTIANA PARRAN RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-4040
Mailing Address - Country:US
Mailing Address - Phone:410-257-2965
Mailing Address - Fax:
Practice Address - Street 1:THE WHITE HOUSE
Practice Address - Street 2:MEDICAL UNIT
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20502-0001
Practice Address - Country:US
Practice Address - Phone:202-757-2476
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101522363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant