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1043971047
IAN JACOB HENRY
RESTON, VA
NPI
1043971047
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
Additional Taxonomies
363AM0700X Physician Assistant, Medical
Enumeration Date
2022-01-03
Last Update Date
2022-06-24
Business Address
IAN JACOB HENRY
1850 TOWN CENTER PKWY
RESTON, VA 20190-3298
Phone number: 703-689-9000
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Mailing Address
IAN JACOB HENRY
127 FORT EVANS RD SE APT A
LEESBURG, VA 20175-4142
Phone number: 703-371-4437
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