Provider Demographics
NPI:1942422431
Name:SHEILA JAHAN MD PC
Entity Type:Organization
Organization Name:SHEILA JAHAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:T
Authorized Official - Last Name:JAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-820-0188
Mailing Address - Street 1:PO BOX 7410
Mailing Address - Street 2:
Mailing Address - City:MERRIFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22116
Mailing Address - Country:US
Mailing Address - Phone:703-820-0188
Mailing Address - Fax:703-820-3793
Practice Address - Street 1:5238 DAWES AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311
Practice Address - Country:US
Practice Address - Phone:703-820-0188
Practice Address - Fax:703-820-3793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010510812084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08732Medicare ID - Type Unspecified
DCG01231Medicare ID - Type Unspecified
DE5232Medicare ID - Type UnspecifiedRR MEDICARE