Provider Demographics
NPI:1215580139
Name:JONES, DOMINIQUE L (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:L
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:DOMINIQUE
Other - Middle Name:L
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3323 PUMPHREY DR
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-4308
Mailing Address - Country:US
Mailing Address - Phone:202-848-0801
Mailing Address - Fax:
Practice Address - Street 1:3323 PUMPHREY DR
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-4308
Practice Address - Country:US
Practice Address - Phone:202-848-0801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3747P1801X
MD202843747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD20284Medicaid