Basic Information
| Provider Information | |||||||||
| NPI: | 1679911580 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADAM | ||||||||
| FirstName: | JESSALYNN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 BOULDERS PARKWAY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NORTH CHESTERFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042153063 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6355 WALKER LANE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038105210 | ||||||||
| FaxNumber: | 7038105418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2013 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | MT205100 | PA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2081S0010X | D86141 | MD | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine |
No ID Information.