Provider Demographics
NPI:1699727339
Name:PRICE, JERRY T (MD)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:T
Last Name:PRICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 NATIONWIDE DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4272
Mailing Address - Country:US
Mailing Address - Phone:434-200-6933
Mailing Address - Fax:434-200-6934
Practice Address - Street 1:1901 TATE SPRINGS RD
Practice Address - Street 2:EMERGENCY DEPT.
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1109
Practice Address - Country:US
Practice Address - Phone:434-200-3027
Practice Address - Fax:434-200-3265
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101041338207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006082238Medicaid
D80393Medicare UPIN
VA006082238Medicaid
P00384244Medicare PIN
VAVV9574AMedicare PIN
P00384244Medicare PIN