Provider Demographics
NPI:1952748659
Name:MA, JONATHAN TIEN (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:TIEN
Last Name:MA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 980315
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0315
Mailing Address - Country:US
Mailing Address - Phone:804-828-9436
Mailing Address - Fax:804-828-2983
Practice Address - Street 1:1000 E BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-1930
Practice Address - Country:US
Practice Address - Phone:804-828-9436
Practice Address - Fax:804-828-2983
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101260132208000000X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics