Individual
DR. SUPRIYA JAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3023 HAMAKER CT STE 300, FAIRFAX, VA 22031-2240
(703) 876-2788
Mailing address
300 COMMUNITY DR, MANHASSET, NY 11030-3816
(516) 562-0100
Taxonomy
Speciality
Code
Description
License number
State
2080P0201X
Pediatric Allergy/Immunology Physician
Primary
0101264109
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
VA
Enumeration date
03/23/2013
Last updated
08/29/2018
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