Provider Demographics
NPI:1013946334
Name:ROSS, JENNIFER LYNN (MD)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4510 PLANK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-0138
Mailing Address - Country:US
Mailing Address - Phone:540-870-6550
Mailing Address - Fax:540-870-6552
Practice Address - Street 1:4510 PLANK RD STE 200
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-0138
Practice Address - Country:US
Practice Address - Phone:540-870-6550
Practice Address - Fax:540-870-6552
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71514207R00000X
VA0101263981207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine