Provider Demographics
NPI:1679625248
Name:P JEAN DREW MD PLC
Entity type:Organization
Organization Name:P JEAN DREW MD PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:P
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-426-4900
Mailing Address - Street 1:9683 A MAIN STREET
Mailing Address - Street 2:WOODSON SQUARE
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3755
Mailing Address - Country:US
Mailing Address - Phone:703-426-4900
Mailing Address - Fax:703-426-4955
Practice Address - Street 1:9683 A MAIN STREET
Practice Address - Street 2:WOODSON SQUARE
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3755
Practice Address - Country:US
Practice Address - Phone:703-426-4900
Practice Address - Fax:703-426-4955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046952207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA187798Medicare PIN
E89139Medicare UPIN