Individual
JACOB A NINAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4660 KENMORE AVE STE 1018, ALEXANDRIA, VA 22304-1306
(703) 208-3155
(703) 823-5723
Mailing address
3040 WILLIAMS DR STE 100, FAIRFAX, VA 22031-4618
(571) 350-8400
(703) 940-8697
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
0101248453
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427009083
—
VA
Enumeration date
05/16/2006
Last updated
10/24/2022
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