Provider Demographics
NPI:1487642872
Name:PLOTSKY, JONATHAN SANDERS (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:SANDERS
Last Name:PLOTSKY
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 1:14705 MENTMORE PL
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2577
Mailing Address - Country:US
Mailing Address - Phone:301-294-1306
Mailing Address - Fax:
Practice Address - Street 1:15225 SHADY GROVE RD
Practice Address - Street 2:STE 102
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3254
Practice Address - Country:US
Practice Address - Phone:301-330-0661
Practice Address - Fax:301-977-6940
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038589207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD000K67J46Medicare PIN
E36934Medicare UPIN