Provider Demographics
NPI:1467652644
Name:GINET, JEBIN JAMES (IDC)
Entity Type:Individual
Prefix:
First Name:JEBIN
Middle Name:JAMES
Last Name:GINET
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14900 PARK CENTRAL RD
Mailing Address - Street 2:
Mailing Address - City:THURMONT
Mailing Address - State:MD
Mailing Address - Zip Code:21788-1501
Mailing Address - Country:US
Mailing Address - Phone:301-271-1460
Mailing Address - Fax:301-271-1464
Practice Address - Street 1:14900 PARK CENTRAL RD
Practice Address - Street 2:
Practice Address - City:THURMONT
Practice Address - State:MD
Practice Address - Zip Code:21788-1501
Practice Address - Country:US
Practice Address - Phone:301-271-1460
Practice Address - Fax:301-271-1464
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic