Provider Demographics
NPI:1336111434
Name:ALLEY, JERRI (MD)
Entity Type:Individual
Prefix:MS
First Name:JERRI
Middle Name:
Last Name:ALLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JERRI
Other - Middle Name:ALLEY
Other - Last Name:ALEXIOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4549 SPOTSWOOD TRAIL
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PENN LAIRD
Mailing Address - State:VA
Mailing Address - Zip Code:22846
Mailing Address - Country:US
Mailing Address - Phone:540-433-8700
Mailing Address - Fax:540-433-8080
Practice Address - Street 1:4549 SPOTSWOOD TRAIL
Practice Address - Street 2:SUITE 8
Practice Address - City:PENN LAIRD
Practice Address - State:VA
Practice Address - Zip Code:22846
Practice Address - Country:US
Practice Address - Phone:540-433-8700
Practice Address - Fax:540-433-8080
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231136207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5727789OtherANTHEM BCBS
VA5727789OtherANTHEM BCBS
VAH14808Medicare UPIN