Provider Demographics
NPI:1972764165
Name:KALAFATICH, JAMIE M (DO)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:M
Last Name:KALAFATICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:R
Other - Last Name:MATHERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:16890 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4059
Mailing Address - Country:US
Mailing Address - Phone:434-200-7210
Mailing Address - Fax:434-525-2138
Practice Address - Street 1:16890 FOREST RD
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4059
Practice Address - Country:US
Practice Address - Phone:434-200-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202308207Q00000X
MN56344207Q00000X
VA0116018762207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA019090C58Medicare PIN