Provider Demographics
NPI:1851333504
Name:DEKKER, JAN JACOB (MD,PHD,FACS)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:JACOB
Last Name:DEKKER
Suffix:
Gender:M
Credentials:MD,PHD,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:MERRIFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22116-0546
Mailing Address - Country:US
Mailing Address - Phone:703-573-6985
Mailing Address - Fax:703-573-7154
Practice Address - Street 1:8316 ARLINGTON BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5207
Practice Address - Country:US
Practice Address - Phone:703-573-6985
Practice Address - Fax:703-573-7154
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039002174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7312610Medicaid
VAB94497Medicare UPIN
VA7312610Medicaid