Provider Demographics
NPI:1902829484
Name:JEFFER, EDWARD KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:KENNETH
Last Name:JEFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 S GEORGE MASON DR
Mailing Address - Street 2:415N
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-3758
Mailing Address - Country:US
Mailing Address - Phone:703-578-1068
Mailing Address - Fax:
Practice Address - Street 1:3701 S GEORGE MASON DR
Practice Address - Street 2:415N
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-3758
Practice Address - Country:US
Practice Address - Phone:703-578-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010533782084P0800X
NV85042084P0800X
MS147062084P0800X
NC99002632084P0800X
SC207442084P0800X
AL000195152084P0800X
GA0411432084P0800X
CAG136252084P0800X
TNMD00000277492084P0800X
LAMD.11555R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG43468Medicare UPIN