Provider Demographics
NPI:1861447500
Name:JINICH, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:JINICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 LAMB CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6345
Mailing Address - Country:US
Mailing Address - Phone:540-731-2328
Mailing Address - Fax:540-639-3950
Practice Address - Street 1:2900 LAMB CIR STE 301
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6345
Practice Address - Country:US
Practice Address - Phone:540-731-2328
Practice Address - Fax:540-639-3950
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12328207RC0000X
VA0101262078207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1861447500Medicaid
MT1861447500Medicaid