Provider Demographics
NPI:1750389987
Name:MINERA, JORGE (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:MINERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 BLACKWELL RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2639
Mailing Address - Country:US
Mailing Address - Phone:540-347-4400
Mailing Address - Fax:
Practice Address - Street 1:493 BLACKWELL RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2639
Practice Address - Country:US
Practice Address - Phone:540-347-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1750389987Medicaid
I22845Medicare UPIN
VA1750389987Medicaid