Provider Demographics
NPI:1942254172
Name:GIVAN, JASON D (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:GIVAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:101 CANDLEWOOD CT STE 101
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2654
Practice Address - Country:US
Practice Address - Phone:434-363-4190
Practice Address - Fax:434-363-4191
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-09-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101248532207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA001207301Medicare Oscar/Certification
VAVVC787D372Medicare PIN