Provider Demographics
NPI:1104891373
Name:GRIFFITHS, JACQUELINE D (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:D
Last Name:GRIFFITHS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JAQUELINE
Other - Middle Name:D
Other - Last Name:GRIFFITHS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12110 SUNSET HILLS RD
Mailing Address - Street 2:SUITE C-50
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5852
Mailing Address - Country:US
Mailing Address - Phone:703-834-9777
Mailing Address - Fax:703-834-8187
Practice Address - Street 1:12110 SUNSET HILLS RD
Practice Address - Street 2:SUITE C-50
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5852
Practice Address - Country:US
Practice Address - Phone:703-834-9777
Practice Address - Fax:703-834-8187
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051056207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G02182J01Medicare PIN
F93876Medicare UPIN