Provider Demographics
NPI:1053562009
Name:THIARA, JASSER (MD)
Entity type:Individual
Prefix:DR
First Name:JASSER
Middle Name:
Last Name:THIARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13890 BRADDOCK RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2437
Mailing Address - Country:US
Mailing Address - Phone:203-673-9656
Mailing Address - Fax:571-526-5598
Practice Address - Street 1:13890 BRADDOCK RD STE 201
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2437
Practice Address - Country:US
Practice Address - Phone:203-673-9656
Practice Address - Fax:571-526-5598
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101250955207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology