Provider Demographics
NPI:1174688592
Name:DINTAMAN, JAY MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:MICHAEL
Last Name:DINTAMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7309 TAKOMA AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4103
Mailing Address - Country:US
Mailing Address - Phone:202-257-3176
Mailing Address - Fax:
Practice Address - Street 1:4494 PALMER RD N
Practice Address - Street 2:BLDG 10, 6TH FLOOR
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814
Practice Address - Country:US
Practice Address - Phone:202-257-3176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA927032080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine