ASHIF K JETHAVA (NPI# 1669632782) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669632782 |
| Entity Type | Individual |
| Full Name | ASHIF K JETHAVA |
| Credential | MD |
| Practice Address |
4720 Puddledock Rd Suite 100b Prince George VA 23875 |
| Mailing Address |
2201 E Main Street Suite 201 Richmond VA 23223 |
| Practice Telephone | 5083341000 |
| Mailing Telephone | 8046433061 |
| Mailing Fax Number | 8046433817 |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2019-04-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 262848 | MA | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | 049340 | CT | Allopathic & Osteopathic Physicians |
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
0101264655 | VA | Allopathic & Osteopathic Physicians |
| N | 208M00000X | Hospitalist | 049340 | CT | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | 262848 | MA | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 110103533/A | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 200 Medical Park Blvd, Petersburg, VA 238059274 | 2406863300 |
| Street Address |
4720 PUDDLEDOCK RD SUITE 100B |
| City | PRINCE GEORGE |
| State | VA |
| Zip Code | 23875 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023087368 | Mubashir A Khan | Psychiatry & Neurology | 4720 Puddledock Rd, Suite 100, Prince George, VA 23875-1237 | 2006-03-17 |
| 1710475629 | Vpk Shah Meds LLC | Pharmacy | 4720 Puddledock Rd, Prince George, VA 23875-1275 | 2018-04-26 |
| 1861747289 | Bushra Khan | Psychiatry & Neurology | 4720 Puddledock Rd, Suite 100, Prince George, VA 23875-1275 | 2012-07-23 |
| 1710154786 | Dawen Bu | Psychiatry & Neurology | 4720 Puddledock Rd, Suite 100, Prince George, VA 23875-1237 | 2008-05-09 |
| 1124087812 | Neuro Care of Virginia PC | Psychiatry & Neurology | 4720 Puddledock Rd, Suite 100, Prince George, VA 23875-1237 | 2006-03-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083228902 | Lr Counseling Services, LLC | Community/Behavioral Health | 5000 Owens Way, Apt. 622, Prince George, VA 23875 | 2020-09-08 |
| 1053815423 | Yolanda Larrette Hoag | Nurse Practitioner | 4600 Puddledock Rd, Prince George, VA 23875 | 2018-03-21 |
| 1932534864 | Foundation for Care LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4301 Montreal Ave., Prince George, VA 23875 | 2013-09-11 |
| 1073889697 | Jemina M Liverman | Nurse Practitioner | 4260 Crossing Blvd, Prince George, VA 23875 | 2012-03-28 |
| 1245412717 | Prince George County Public Schools | Local Education Agency (LEA) | 6410 Courts Drive, Prince George, VA 23875 | 2007-11-27 |
| 1952330193 | Commonwealth of Virginia State Board of Health | Public Health or Welfare | 6459 Administration Dr., Prince George, VA 23875 | 2006-07-01 |
| 1598173155 | Divine Spine Chiropractic | Chiropractor | 4205 Crossings Blvd, Prince George, VA 23875 | 2014-07-28 |
| 1043873664 | Branbur Dialysis LLC | Clinic/Center | 4650 Puddledock Rd, Prince George, VA 23875-1235 | 2019-04-18 |
| 1033754874 | Jessica M Larche | Nurse Practitioner | 4600 Puddledock Rd, Prince George, VA 23875-1235 | 2019-11-15 |
| 1699744839 | Yogesh K Gandhi | Internal Medicine | 4730 Puddledock Rd, Suite 100, Prince George, VA 23875-1237 | 2006-03-17 |
| Find all providers in zip 23875 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316416522 | Southwest Virginia Nephrology LLC | Internal Medicine | 4806 Pleasant Hill Dr Ste 102, Roanoke, VA 24018-3440 | 2018-11-16 |
| 1780081059 | Belen Nunez | Internal Medicine | 3400 S Crater Rd Ste B, Petersburg, VA 23805-9252 | 2014-12-02 |
| 1770903585 | Salah-ud-din Amjad | Internal Medicine | 480 W Jubal Early Dr Ste 200, Winchester, VA 22601 | 2014-04-19 |
| 1699012005 | Barry S. Strauch | Internal Medicine | 1468 Evans Farm Dr, Mc Lean, VA 22101-5652 | 2013-01-07 |
| 1770858847 | Amanda D. Renaghan | Internal Medicine | 199 Spotnap Rd Ste 1, Charlottesville, VA 22911-8827 | 2012-03-21 |
| 1952671067 | Sumeyye Calp Inal | Internal Medicine | 739 Thimble Shoals Blvd Ste 801, Newport News, VA 23606 | 2012-01-05 |
| 1598080186 | Vineet Kumaar Jassal | Internal Medicine | 3930 Walnut St Ste 101, Fairfax, VA 22030-4750 | 2010-04-07 |
| 1538497698 | James Macleod Cox | Internal Medicine | 4222 Coles Point Way, Glen Allen, VA 23060-7242 | 2009-12-01 |
| 1568625408 | Mahesh Krishnan | Internal Medicine | 1371 Lancia Dr, Mc Lean, VA 22102-2230 | 2008-07-09 |
| 1194907527 | Usama Taha Hussein | Internal Medicine | 1800 Camelot Dr Ste 401, Virginia Beach, VA 23454-2440 | 2007-11-27 |
| Find all providers with the same taxonomy | ||||
| City | PRINCE GEORGE |
| Zip Code | 23875 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.