Provider Demographics
NPI:1912113168
Name:OLDHAM, JENNIFER DELUCA (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DELUCA
Last Name:OLDHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:DELUCA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1568
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-6568
Mailing Address - Country:US
Mailing Address - Phone:540-825-3100
Mailing Address - Fax:540-829-5440
Practice Address - Street 1:650 LAUREL ST
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3910
Practice Address - Country:US
Practice Address - Phone:540-825-5656
Practice Address - Fax:540-825-1612
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012412572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4945361Medicaid
VA4945361Medicaid
VA016037R23Medicare PIN