Provider Demographics
NPI:1275674129
Name:JERMYN, ELLIOTT L (PT)
Entity Type:Individual
Prefix:MR
First Name:ELLIOTT
Middle Name:L
Last Name:JERMYN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 ROCK SPRING DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1105
Mailing Address - Country:US
Mailing Address - Phone:301-564-6022
Mailing Address - Fax:
Practice Address - Street 1:6500 ROCK SPRING DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1105
Practice Address - Country:US
Practice Address - Phone:301-564-6022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20355174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist