Provider Demographics
NPI:1346293388
Name:DE JONGE, KARL E (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:E
Last Name:DE JONGE
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 1:6304 BROAD BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3342
Mailing Address - Country:US
Mailing Address - Phone:202-288-9558
Mailing Address - Fax:
Practice Address - Street 1:3180 FAIRVIEW PARK DR STE 500
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-4516
Practice Address - Country:US
Practice Address - Phone:703-538-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD20969207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD180981401Medicaid
DC025712900Medicaid
VA7603452Medicaid
DCF44289Medicare UPIN
DC025712900Medicaid