NPIMap

Organization Active NPI

Marymount University

  • Adult Medicine Physician
  • Arlington, VA
National Provider Identifier
1215522297
Registry record updated Mar 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
Legal business name
MARYMOUNT UNIVERSITY
Practice address
2807 N Glebe Rd
Berg Hall 1014
Arlington, VA 22207-4299
Phone
(703) 284-1610
Fax
(703) 284-3816
NPI assigned
Mar 2, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Jennifer Claire Gagnon, FNP-CNPI 1770937617
Title
Director
Phone
(703) 284-1610

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QA0505X Primary

Addresses

Primary practice location

2807 N Glebe Rd
Berg Hall 1014
Arlington, VA 22207-4299

Mailing address

2807 N Glebe Rd
Berg Hall 1014
Arlington, VA 22207-4299
Phone (703) 284-1610

Other names 1

  • Marymount University Student Health Services Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Arlington

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D0701797Student Health/Marymount University2807 North Glebe Road, Arlington, VA 22207Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

2807 N Glebe Rd
Arlington, VA 22207
Phone (703) 284-1610

2807 N Glebe Rd
#1014
Arlington, VA 22207
Phone (703) 284-1610

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679270400000",
    "number": "1215522297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2807 N GLEBE RD",
            "address_2": "BERG HALL 1014",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222074299",
            "telephone_number": "703-284-1610",
            "fax_number": "703-284-3816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2807 N GLEBE RD",
            "address_2": "BERG HALL 1014",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222074299",
            "telephone_number": "703-284-1610",
            "fax_number": "703-284-3816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYMOUNT UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-02",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A",
        "authorized_official_last_name": "GAGNON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "CLAIRE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "703-284-1610",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Arlington",
            "affiliation": "N",
            "address_1": "2807 North Glebe Road",
            "address_2": "SHS, Berg Hall 1014",
            "city": "Arlington",
            "state": "VA",
            "country_code": "US",
            "postal_code": "22207",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Marymount University Student Health Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Arlington, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.