Provider Demographics
NPI:1932332665
Name:JORGE A. NARANJO, M.D., P.C.
Entity Type:Organization
Organization Name:JORGE A. NARANJO, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:NARANJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-654-6545
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:BOYKINS
Mailing Address - State:VA
Mailing Address - Zip Code:23827-0365
Mailing Address - Country:US
Mailing Address - Phone:757-654-6545
Mailing Address - Fax:757-654-6176
Practice Address - Street 1:18141 WOODLAND PARK DR
Practice Address - Street 2:
Practice Address - City:BOYKINS
Practice Address - State:VA
Practice Address - Zip Code:23827-0365
Practice Address - Country:US
Practice Address - Phone:757-654-6545
Practice Address - Fax:757-654-6176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101016682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1942304175OtherNPI, INDIVIDUAL
VA0000000323053OtherVIRGINIA
VA005614635Medicaid
VA1942304175OtherNPI, INDIVIDUAL
VA005614635Medicaid