DR. SUPRIYA JAIN (NPI# 1528300910) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528300910 |
| Entity Type | Individual |
| Full Name | DR. SUPRIYA JAIN |
| Credential | M.D. |
| Practice Address |
3023 Hamaker Ct Ste 300 Fairfax VA 22031-2240 |
| Mailing Address |
300 Community Dr Manhasset NY 11030-3816 |
| Practice Telephone | 7038762788 |
| Mailing Telephone | 5165620100 |
| Enumeration Date | 2013-03-23 |
| Last Update Date | 2018-08-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0201X |
Pediatrics Specialization: Pediatric Allergy/Immunology |
0101264109 | VA | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | PENDING | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 300 Community Dr, Manhasset, NY 110303816 | 5165620100 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639597529 | Supriya Jain | Radiology | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2014-03-29 |
| 1669701298 | Supriya Jain | Pediatrics | New York Medical College, Munger Pavilion, Room 618, Valhalla, NY 10595 | 2009-12-10 |
| Street Address |
3023 HAMAKER CT STE 300 |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22031-2240 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245324185 | Leon Elwin Moores | Neurological Surgery | 3023 Hamaker Ct Ste 300, Fairfax, VA 22031-2240 | 2006-10-03 |
| 1588279780 | Erica Price | Genetic Counselor, MS | 3023 Hamaker Ct Ste 300, Fairfax, VA 22031-2240 | 2020-09-14 |
| 1528677127 | Lucy Drayson | Genetic Counselor, MS | 3023 Hamaker Ct Ste 300, Fairfax, VA 22031-2240 | 2020-07-29 |
| 1619506854 | Anita Marie Vitale | Psychologist | 3023 Hamaker Ct Ste 300, Fairfax, VA 22031-2240 | 2020-04-08 |
| 1730459801 | Akilah Renee Mikel | Nurse Practitioner | 3023 Hamaker Ct Ste 300, Fairfax, VA 22031-2240 | 2012-01-06 |
| 1013131010 | Darlene Mansoor | Allergy & Immunology | 3023 Hamaker Ct Ste 300, Fairfax, VA 22031-2240 | 2007-04-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902414105 | Su Jung Kang | Dentist | 9661-c Main Street, Fairfax, VA 22031 | 2020-07-14 |
| 1346896347 | Fuling Guo | Acupuncturist | 3013 James St, Fairfax, VA 22031 | 2019-08-15 |
| 1902458797 | Kayla Callister | Psychologist | 2270 Willow Oaks Corporate Drive, Fairfax, VA 22031 | 2019-07-11 |
| 1790349801 | Fairfax Dental Esthetics | Dentist | 9621 Fairfax Blvd., Fairfax, VA 22031 | 2019-04-24 |
| 1417427675 | Kathryn Yen Ho | Speech-Language Pathologist | 8270 Willow Oaks Corporate Drive Suite 2127, Falls Church, VA 22031 | 2018-11-30 |
| 1932681376 | Joanne Towers | Physician Assistant | 3025 Hamaker Court Suite 300, Fairfax, VA 22031 | 2018-09-01 |
| 1790262020 | S Renee Dennis | Nurse Practitioner | 8316 Arlington Blvd Ste 500, Fairfax, VA 22031 | 2018-07-19 |
| 1013493451 | Elizabeth Joan Dwyer | Physician Assistant | 3023 Hamaker Ct., Suite 500, Fairfax, VA 22031 | 2018-07-18 |
| 1316432669 | Delta Pharm LLC | Pharmacy | 8316 Arlington Blvd Ste 100, Fairfax, VA 22031 | 2018-06-28 |
| 1629567656 | Laura Breeden | Acupuncturist | 3846 Lyndhurst Dr Apt 301, Fairfax, Va, VA 22031 | 2018-05-04 |
| Find all providers in zip 22031 | ||||
| Taxonomy Code | 2080P0201X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Allergy/Immunology |
| A pediatrician who specializes in the diagnosis and treatment of allergies, allergic reactions, and immunologic diseases in children. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: title modified, definition added, source added] Additional Resources: A Certification of Special Qualifications (CSQ) is issued by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285622183 | Derek K Johnson | Pediatrics | 3903a Fair Ridge Dr, Fairfax, VA 22033-2938 | 2005-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972169910 | Erin Bartlett | Pediatrics | 22505 Landmark Ct Ste 225, Ashburn, VA 20148-6503 | 2019-05-15 |
| 1821153172 | John R Vroom | Pediatrics | 6501loisdale Court, Springfield, VA 22150-1885 | 2006-12-27 |
| 1184735334 | Lan Chau Tu | Pediatrics | 6404 Seven Corners Place, #g, Falls Church, VA 22044-2304 | 2006-08-31 |
| 1518304468 | Samantha C Minnicozzi | Pediatrics | 1204 W Main St, Charlottesville, VA 22903-2824 | 2013-06-02 |
| 1144514092 | Jonathan A Hemler | Pediatrics | 1204 W Main St, Charlottesville, VA 22903-2824 | 2011-06-07 |
| 1710027826 | Peter W. Heymann | Pediatrics | Uva Primary Care Ctr, Lee Street, Charlottesville, VA 22908-0001 | 2007-02-07 |
| 1679658363 | Adult and Pediatric Healthcare | Pediatrics | 100 Elden St, Suite 10, Herndon, VA 20170-4873 | 2006-10-25 |
| 1366495228 | Cristian Rodriguez | Pediatrics | 3450 N Beauregard St, Suite 1, Alexandria, VA 22302-1200 | 2006-05-19 |
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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.