Provider Demographics
NPI:1609877018
Name:JETT, PATRICIA POLK (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:POLK
Last Name:JETT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1111 BENFIELD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3002
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:410-729-5156
Practice Address - Street 1:129 LUBRANO DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7566
Practice Address - Country:US
Practice Address - Phone:410-266-5852
Practice Address - Fax:410-266-5095
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2012-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD50756207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0597124OtherAETNA CAPITATED
MD5743200OtherAETNA FEE FOR SERVICE
MD544390-02OtherCAREFIRST RENDERING
MD080093090OtherRAILROAD MEDICARE
MD860241OtherMAMSI PRIMARY CARE
MDP14116OtherCAREFIRST MPOS
MD2171119OtherCIGNA PROVIDER NUMBER
MD260241OtherMAMSI SPECIALIST
MD7605-0014OtherCAREFIRST BLUECHOICE
MD452011400Medicaid
MD031003OtherJHHC PROVIDER NUMBER
MD260241OtherMAMSI SPECIALIST
MD7605-0014OtherCAREFIRST BLUECHOICE