Jasser Thiara, M.D.

Key facts

NPI

1053562009

Entity type

Individual (NPI type 1)

Primary specialty

Obstetrics & Gynecology Physician 207V00000X

License

0101250955 (VA)

Practice address

13890 Braddock Rd Ste 201
Centreville, VA 20121-2437

Phone

(203) 673-9656

Fax

(571) 526-5598

NPI assigned

Oct 8, 2008

Sex

Male

Sole proprietor

No

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• NTMT Group Obstetrics & Gynecology Physician · Fairfax, VA · NPI 1871019323
  NPD Authorized official OBSTETRICS & GYNECOLOGY
• Prosperity Labs LLC Clinical Medical Laboratory · Fairfax, VA · NPI 1336918283
  NPD (past)
• Frederick Health Hospital Inc General Acute Care Hospital · Frederick, MD · NPI 1538165527
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 9, 2023.

{
    "created_epoch": "1223424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1053562009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13890 BRADDOCK RD STE 201",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201212437",
            "telephone_number": "203-673-9656",
            "fax_number": "571-526-5598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13890 BRADDOCK RD STE 201",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201212437",
            "telephone_number": "203-673-9656",
            "fax_number": "571-526-5598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIARA",
        "first_name": "JASSER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-08",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "VA",
            "license": "0101250955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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