Individual
IAN JACOB HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1850 TOWN CENTER PKWY, RESTON, VA 20190-3298
(703) 689-9000
Mailing address
127 FORT EVANS RD SE APT A, LEESBURG, VA 20175-4142
(703) 371-4437
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
01/03/2022
Last updated
06/24/2022
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