Provider Demographics
NPI:1295727816
Name:FRUITERMAN, JAN PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:PAUL
Last Name:FRUITERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:18318 FAIRWAY OAKS SQ
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8460
Mailing Address - Country:US
Mailing Address - Phone:571-243-8806
Mailing Address - Fax:703-779-1795
Practice Address - Street 1:900 S WASHINGTON ST
Practice Address - Street 2:ST 300
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4020
Practice Address - Country:US
Practice Address - Phone:703-532-2500
Practice Address - Fax:703-237-1184
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2010-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101029267207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6211607Medicaid
VA6211607Medicaid
VA016060F43Medicare ID - Type Unspecified