Provider Demographics
NPI:1053548917
Name:DAO, JENNIFER BAGDADY (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BAGDADY
Last Name:DAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:BAGDADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8136 OLD KEENE MILL RD STE B300
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1856
Mailing Address - Country:US
Mailing Address - Phone:703-451-6111
Mailing Address - Fax:703-451-6247
Practice Address - Street 1:8136 OLD KEENE MILL RD STE B300
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1856
Practice Address - Country:US
Practice Address - Phone:703-451-6111
Practice Address - Fax:703-451-6247
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101252410207WX0110X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
54-1168250OtherTAX ID