Individual
IFFAT JAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
14349 GIDEON DR FL 2, WOODBRIDGE, VA 22192-4641
(571) 472-8762
(571) 472-6724
Mailing address
PO BOX 37189, BALTIMORE, MD 21297-3189
(571) 423-5699
(571) 423-5698
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
0101235412
VA
207Q00000X
Family Medicine Physician
Primary
0101235412
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
I01322
UPIN
VA
Enumeration date
04/25/2006
Last updated
04/23/2026
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