Provider Demographics
NPI:1326056904
Name:F DANIEL JACKSON, MD, PA
Entity Type:Organization
Organization Name:F DANIEL JACKSON, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:F
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-759-3817
Mailing Address - Street 1:PO BOX 1692
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1692
Mailing Address - Country:US
Mailing Address - Phone:301-759-3817
Mailing Address - Fax:301-759-3286
Practice Address - Street 1:32 CORPORATE DR
Practice Address - Street 2:GRANTSVILLE MEDICAL CENTER
Practice Address - City:GRANTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21536-1259
Practice Address - Country:US
Practice Address - Phone:301-895-3922
Practice Address - Fax:301-895-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD433LMedicare ID - Type Unspecified