Provider Demographics
NPI:1710044789
Name:SHORT, JOHN J (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:SHORT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5454 WISCONSIN AVE
Mailing Address - Street 2:SUITE 1050
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6901
Mailing Address - Country:US
Mailing Address - Phone:301-652-0644
Mailing Address - Fax:301-652-8722
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:SUITE 1050
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6901
Practice Address - Country:US
Practice Address - Phone:301-652-0644
Practice Address - Fax:301-652-8722
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0020518207N00000X
DCMD10124207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D84570Medicare UPIN