Provider Demographics
NPI:1326080193
Name:JISON, MARIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:L
Last Name:JISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:LEONOR GONZALES
Other - Last Name:JISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11006 VEIRS MILL RD
Mailing Address - Street 2:PMB 261
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2582
Mailing Address - Country:US
Mailing Address - Phone:888-340-3330
Mailing Address - Fax:240-489-6262
Practice Address - Street 1:10400 CONNECTICUT AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-3910
Practice Address - Country:US
Practice Address - Phone:888-340-3330
Practice Address - Fax:240-489-6262
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010237603208M00000X
VA0101237603207RC0200X
MDD0054450207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1689687162OtherGROUP NPI
MDG02443Medicare PIN
MD1689687162OtherGROUP NPI