Provider Demographics
NPI:1790767069
Name:WASSON, JANET L (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:WASSON
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 1:9658 MARLBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772
Mailing Address - Country:US
Mailing Address - Phone:241-788-7502
Mailing Address - Fax:240-838-5184
Practice Address - Street 1:9658 MARLBORO PIKE
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772
Practice Address - Country:US
Practice Address - Phone:240-788-7502
Practice Address - Fax:301-485-8467
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044979208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4410515OtherAETNA PPO
145724700OtherDEPARTMENT OF LABOR
JR99Medicare ID - Type Unspecified
6817214OtherAETNA HMO
269737OtherKAISER PERMANTE
F70737Medicare UPIN
MD162211100Medicaid
P00700857Medicare PIN
MD52914605OtherCAREFIRST
K5850008OtherCAREFIRST
131064ZADNMedicare PIN