Provider Demographics
NPI:1972581049
Name:ROLL, JEANNE (MD)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:ROLL
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 1:5219 LANKFORD HWY
Mailing Address - Street 2:
Mailing Address - City:NEW CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:23415-3332
Mailing Address - Country:US
Mailing Address - Phone:757-824-5676
Mailing Address - Fax:757-824-5872
Practice Address - Street 1:5219 LANKFORD HWY
Practice Address - Street 2:
Practice Address - City:NEW CHURCH
Practice Address - State:VA
Practice Address - Zip Code:23415-3332
Practice Address - Country:US
Practice Address - Phone:757-824-5676
Practice Address - Fax:757-824-5872
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049451207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine