Provider Demographics
NPI:1235949173
Name:JOSE, PEDRO A (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:A
Last Name:JOSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6721 SPRINGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-3912
Mailing Address - Country:US
Mailing Address - Phone:703-550-8042
Mailing Address - Fax:
Practice Address - Street 1:6721 SPRINGFIELD DR
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-3912
Practice Address - Country:US
Practice Address - Phone:703-550-8042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010220912080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology