Provider Demographics
NPI:1124185681
Name:GARCIA, JESSE PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:PATRICK
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:METROPOLITAN
Other - Middle Name:VASCULAR
Other - Last Name:ACCESS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ENTITY 2 NAME
Mailing Address - Street 1:5139 BRAWNER PL
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-8705
Mailing Address - Country:US
Mailing Address - Phone:202-531-3630
Mailing Address - Fax:949-798-6963
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:POB SOUTH 408
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-531-3630
Practice Address - Fax:949-798-6963
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00645282086S0129X
DCMD035947208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1140 VARNUM ST NE110OtherNEW OFFICE LOCATION
DC3634062OtherMAIL HANDLERS COVENTRY HEALTH
DC1609195585OtherSOLE PROPRITOR METROPOLITAN VASCULAR ACCESS
DCAS63OtherCAREFIRST BCBS
DC057067200Medicaid
DCENTITY 2 INDIVIDUALOtherMETROPOLITAN VASCULAR ACCESS
DC3634062OtherMAIL HANDLERS COVENTRY HEALTH