Provider Demographics
NPI:1689687162
Name:MARIA L JISON MD LLC
Entity Type:Organization
Organization Name:MARIA L JISON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LEONOR
Authorized Official - Last Name:JISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-717-7912
Mailing Address - Street 1:11006 VEIRS MILL RD
Mailing Address - Street 2:PMB 261
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2582
Mailing Address - Country:US
Mailing Address - Phone:240-489-6262
Mailing Address - Fax:240-489-6262
Practice Address - Street 1:11006 VEIRS MILL RD
Practice Address - Street 2:PMB 261
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-2582
Practice Address - Country:US
Practice Address - Phone:240-489-6262
Practice Address - Fax:240-489-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054450207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1326080193OtherINDIVIDUAL NPI
MDG02443Medicare PIN
MDH61141Medicare UPIN