Individual
DR. ANNAMMA J JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1635 N GEORGE MASON DR, STE 240, ARLINGTON, VA 22205-3681
(703) 528-1329
(703) 522-4915
Mailing address
1635 N GEORGE MASON DR, STE 240, ARLINGTON, VA 22205-3681
(703) 528-1329
(703) 522-4915
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
0101034078
VA
207KA0200X
Allergy Physician
Primary
0101034078
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
081723
ANTHEM
—
01
—
29164
M.D.I.P.A
—
01
—
54-1272326
UNITED HEALTHCARE
—
05
—
60-4923-1
—
VA
01
—
8803
CAREFIRST BLUE CROSS BLUE
—
Enumeration date
07/27/2006
Last updated
04/26/2017
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