Basic Information
| Provider Information | |||||||||
| NPI: | 1801017124 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RYAL | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 936 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235010936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574465955 | ||||||||
| FaxNumber: | 7574465196 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 FAIRFAX AVE | ||||||||
| Address2: | SUITE 445 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235071914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574465955 | ||||||||
| FaxNumber: | 7574465196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 01/23/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101241625 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10022014 | 01 | VA | SENTARA/OPTIMA | OTHER | 1801017124 | 05 | VA | MEDICAID | 303765 | 01 | VA | ANTHEM BC/BS (GHENT FAMILY MEDICINE) | OTHER | 2167093 | 01 | VA | UHC/MAMSI | OTHER | -002 -003 -028 | 01 | VA | TRICARE/CHAMPUS | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY | OTHER | PAR | 01 | VA | VIRGINIA PREMIER HEALTH | OTHER | PAR | 01 | VA | CORVEL/CORCARE | OTHER | 07269 | 01 | NC | NC BCBS | OTHER | PAR | 01 | VA | CIGNA | OTHER | 303762 | 01 | VA | ANTHEM BC/BS (INERNAL MEDICINE) | OTHER | PAR | 01 | VA | AETNA | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | PAR | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER |