Provider Demographics
NPI:1952798118
Name:ATVES, JAYSON NICHOLAS (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAYSON
Middle Name:NICHOLAS
Last Name:ATVES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2806
Mailing Address - Country:US
Mailing Address - Phone:440-915-7894
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR RD NW BLDG 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-9686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPO1000164213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASC006904OtherPA STATE BOARD OF PODIATRY