Provider Demographics
NPI:1558520239
Name:JARRIS, ELISE YUMI SHITAMA (MD)
Entity Type:Individual
Prefix:
First Name:ELISE YUMI
Middle Name:SHITAMA
Last Name:JARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 RESERVOIR RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2113
Mailing Address - Country:US
Mailing Address - Phone:202-687-2000
Mailing Address - Fax:202-687-6452
Practice Address - Street 1:3800 RESERVOIR RD NW
Practice Address - Street 2:2 PHC
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-8518
Practice Address - Fax:202-444-2961
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD037165174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC127729YTFMedicare PIN