Provider Demographics
NPI:1932112240
Name:SKAGGS, JEROME D SR (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:D
Last Name:SKAGGS
Suffix:SR
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 1:301 N. 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860
Mailing Address - Country:US
Mailing Address - Phone:804-458-8535
Mailing Address - Fax:804-541-7851
Practice Address - Street 1:308 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2518
Practice Address - Country:US
Practice Address - Phone:804-458-8535
Practice Address - Fax:804-541-7851
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-016624207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1932112240Medicare PIN
VAB09156Medicare UPIN