Provider Demographics
NPI:1346495348
Name:JAVITT, JONATHAN C (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:C
Last Name:JAVITT
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BETHESDA METRO CTR STE 1350
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-6377
Mailing Address - Country:US
Mailing Address - Phone:202-340-1352
Mailing Address - Fax:
Practice Address - Street 1:2 BETHESDA METRO CTR STE 1350
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-6377
Practice Address - Country:US
Practice Address - Phone:202-340-1352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD18281207W00000X
MDD0035429207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB70155Medicare UPIN