Provider Demographics
NPI:1063409530
Name:DWYER, JENNIFER B (MD)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:B
Last Name:DWYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:D
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:116 FOUNDERS WAY
Mailing Address - Street 2:#2
Mailing Address - City:STRASBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22657
Mailing Address - Country:US
Mailing Address - Phone:540-465-3235
Mailing Address - Fax:540-465-3619
Practice Address - Street 1:116 FOUNDERS WAY
Practice Address - Street 2:#2
Practice Address - City:STRASBURG
Practice Address - State:VA
Practice Address - Zip Code:22657
Practice Address - Country:US
Practice Address - Phone:540-465-3235
Practice Address - Fax:540-465-3619
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101102735207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005615810Medicaid
VA383550OtherANTHEM
H39023Medicare UPIN
VAH39023Medicare UPIN
VA005615810Medicaid