# MARTHA JEFFERSON MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MARTHA JEFFERSON HOSPITAL
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1275720559
- **Legal business name:** MARTHA JEFFERSON HOSPITAL
- **Authorized official:** DR. BRUCE CLEMONS MD (VICE PRESIDENT, MEDICAL DIRECTOR)
- **Authorized official phone:** (434) 654-5229

## Contact information

- **Practice address:** 590 PETER JEFFERSON PKWY STE 300, CHARLOTTESVILLE, VA 22911-4628
- **Practice address phone:** (434) 654-7340
- **Practice address fax:** (434) 654-7752
- **Mailing address:** PO BOX 746550, ATLANTA, GA 30374-6550
- **Mailing address phone:** (434) 654-7340
- **Mailing address fax:** (434) 654-7752

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | VA | Yes |
| 207RH0003X | Hematology & Oncology Physician | — | NULL | — |
| 207RH0003X | Hematology & Oncology Physician | — | — | — |
| 207RP1001X | Pulmonary Disease Physician | — | VA | — |
| 207XS0106X | Orthopaedic Hand Surgery Physician | — | VA | — |
| 208000000X | Pediatrics Physician | — | VA | — |
| 208200000X | Plastic Surgery Physician | — | VA | — |
| 208600000X | Surgery Physician | — | VA | — |
| 208M00000X | Hospitalist Physician | — | VA | — |

## Other

- **Enumeration date:** 10/01/2007
- **Last updated:** 09/29/2022