Provider Demographics
NPI:1336708205
Name:JAIN, GAURAV (DO)
Entity Type:Individual
Prefix:
First Name:GAURAV
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13028 MONROE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2997
Mailing Address - Country:US
Mailing Address - Phone:703-899-5644
Mailing Address - Fax:
Practice Address - Street 1:13028 MONROE MANOR DR
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-2997
Practice Address - Country:US
Practice Address - Phone:703-899-5644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022079422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry