Provider Demographics
NPI:1609035377
Name:NORA D. JOSE, MD
Entity type:Organization
Organization Name:NORA D. JOSE, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORA
Authorized Official - Middle Name:DOCTOR
Authorized Official - Last Name:JOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-360-0300
Mailing Address - Street 1:2616 SHERWOOD HALL LN
Mailing Address - Street 2:STE.404
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3100
Mailing Address - Country:US
Mailing Address - Phone:703-360-0300
Mailing Address - Fax:703-799-7074
Practice Address - Street 1:2616 SHERWOOD HALL LN
Practice Address - Street 2:STE.404
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3100
Practice Address - Country:US
Practice Address - Phone:703-360-0300
Practice Address - Fax:703-799-7074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010226072080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA080748OtherBLUE CROSS BLUE SHIELD
VA10231496OtherAMERIGROUP
VA080748OtherANTHEM HEALTHKEEPERS
VA4996OtherCAREFIRST BLUECROSS BLUESHIELD
VA006742173Medicaid
VA4052942OtherAETNA