Individual
JAY PAVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
325 CHARLES H DIMMOCK PKWY STE 100, COLONIAL HEIGHTS, VA 23834-2986
(804) 526-5888
(804) 526-5401
Mailing address
13000 RIVERS BEND BLVD, STE D, CHESTER, VA 23836-8632
(804) 571-5106
(804) 530-1857
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
0101222130
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006800530
—
VA
01
—
200039821
RAILROAD MEDICARE
VA
Enumeration date
07/19/2005
Last updated
12/05/2017
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