Individual
DR. JEREMY BOUSSELOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1701 N GEORGE MASON DR, ARLINGTON, VA 22205-3610
(703) 717-4400
(703) 717-4401
Mailing address
1625 N GEORGE MASON DR STE 345, ARLINGTON, VA 22205-3690
(703) 717-4400
(703) 717-4401
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101255360
VA
208M00000X
Hospitalist Physician
0101255360
VA
Other
Enumeration date
03/24/2011
Last updated
03/28/2022
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