Provider Demographics
NPI:1821012816
Name:JENNINGS, VERDENA ROSS (DO)
Entity Type:Individual
Prefix:DR
First Name:VERDENA
Middle Name:ROSS
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:VERDENA
Other - Middle Name:L
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:111 SHORT ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:VA
Mailing Address - Zip Code:22960-1651
Mailing Address - Country:US
Mailing Address - Phone:540-672-9000
Mailing Address - Fax:540-672-2710
Practice Address - Street 1:111 SHORT ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:VA
Practice Address - Zip Code:22960-1651
Practice Address - Country:US
Practice Address - Phone:540-672-9000
Practice Address - Fax:540-672-2710
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006495207R00000X
VA0102203646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0582221Medicaid
OH0582221Medicaid
OH0582221Medicaid