Basic Information
| Provider Information | |||||||||
| NPI: | 1649385089 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOSE | ||||||||
| FirstName: | NORA | ||||||||
| MiddleName: | DOCTOR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2616 SHERWOOD HALL LN | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223063100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033600300 | ||||||||
| FaxNumber: | 7037997074 | ||||||||
| Practice Location | |||||||||
| Address1: | 2616 SHERWOOD HALL LN | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223063100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033600300 | ||||||||
| FaxNumber: | 7037997074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | 0101022607 | VA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080748 | 01 | VA | ANTHEM PIN | OTHER | 283727 | 01 | VA | AMERIGROUP PIN | OTHER |