Provider Demographics
NPI:1902884901
Name:JEFFERIES, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:JEFFERIES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 PINE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-1244
Mailing Address - Country:US
Mailing Address - Phone:757-810-3232
Mailing Address - Fax:757-788-8816
Practice Address - Street 1:112 PINE CREEK DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-1244
Practice Address - Country:US
Practice Address - Phone:757-810-3232
Practice Address - Fax:757-788-8816
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012293072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1902884901Medicaid
VA1902884901Medicaid
VAP01388466Medicare PIN