Provider Demographics
NPI:1902958986
Name:ACKERMAN, JENNIFER ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 WEST SHIRLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186
Mailing Address - Country:US
Mailing Address - Phone:540-347-9220
Mailing Address - Fax:540-347-0492
Practice Address - Street 1:555 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3028
Practice Address - Country:US
Practice Address - Phone:540-347-5512
Practice Address - Fax:540-341-4646
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102050261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA061010000OtherSOUTHERN HEALTH
VA50820005OtherCAREFIRST PROVIDER #
VAANTHEMOtherANTHEM PROVIDER #
VA7567197OtherAETNA PROVIDER #
VA885925OtherMAMSI PROVIDER #
VA5849667Medicaid
VA112539OtherCIGNA PROVIDER #
VA275675OtherHEALTHKEEPERS
VA112539OtherCIGNA PROVIDER #
VA5849667Medicaid