Provider Demographics
NPI:1629633268
Name:STOKUM, JESSE ALAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:ALAN
Last Name:STOKUM
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 ROCKWELL AVE
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4244
Mailing Address - Country:US
Mailing Address - Phone:724-554-6685
Mailing Address - Fax:
Practice Address - Street 1:22 S GREENE ST STE S-12D
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1590
Practice Address - Country:US
Practice Address - Phone:724-554-6685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program