Provider Demographics
NPI:1699964387
Name:JAN J. DEKKER, M.D., L.L.C.
Entity type:Organization
Organization Name:JAN J. DEKKER, M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:DEKKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:703-573-6985
Mailing Address - Street 1:4307 WYNNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3430
Mailing Address - Country:US
Mailing Address - Phone:703-573-6985
Mailing Address - Fax:703-573-7154
Practice Address - Street 1:8316 ARLINGTON BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5207
Practice Address - Country:US
Practice Address - Phone:703-573-6985
Practice Address - Fax:703-573-7154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039002174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG00874Medicare PIN