Provider Demographics
NPI:1639245459
Name:MCLAVY, JASON SCOTT BURNS (MD)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:SCOTT BURNS
Last Name:MCLAVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:SCOTT
Other - Last Name:MCLAVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11916 BLAIRMONT PL
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5399
Mailing Address - Country:US
Mailing Address - Phone:352-239-1777
Mailing Address - Fax:
Practice Address - Street 1:11916 BLAIRMONT PL
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5399
Practice Address - Country:US
Practice Address - Phone:352-239-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78962207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47249OtherBCBS - FL
FLP00466892OtherRR MEDICARE
FL256116600Medicaid
FLP00466892Medicare PIN
FLK6811Medicare ID - Type Unspecified
FL256116600Medicaid
FL47249OtherBCBS - FL