Provider Demographics
NPI:1851515472
Name:DR. JACQUELINE D. GRIFFITHS, MD PC
Entity Type:Organization
Organization Name:DR. JACQUELINE D. GRIFFITHS, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-834-9777
Mailing Address - Street 1:12110 SUNSET HILLS RD
Mailing Address - Street 2:SUITE C50
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5852
Mailing Address - Country:US
Mailing Address - Phone:703-834-9777
Mailing Address - Fax:703-834-8187
Practice Address - Street 1:12110 SUNSET HILLS RD
Practice Address - Street 2:SUITE C50
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5852
Practice Address - Country:US
Practice Address - Phone:703-834-9777
Practice Address - Fax:703-834-8187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG02182Medicare PIN