Provider Demographics
NPI:1427061605
Name:CARR, JENIFER E (MD)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:E
Last Name:CARR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5360 TWIN HICKORY RD
Mailing Address - Street 2:COMMONWEALTH PRIMARY CARE
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5682
Mailing Address - Country:US
Mailing Address - Phone:804-346-3200
Mailing Address - Fax:804-346-4075
Practice Address - Street 1:1800 GLENSIDE DR STE 105
Practice Address - Street 2:COMMONWEALTH PRIMARY CARE
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3769
Practice Address - Country:US
Practice Address - Phone:804-288-0399
Practice Address - Fax:804-285-0088
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2015-11-16
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Provider Licenses
StateLicense IDTaxonomies
VA0101045526207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005609640Medicaid
VA005609640Medicaid
VA001220H48Medicare PIN