Provider Demographics
NPI:1821231507
Name:MOHASSEL, JANA VANDEGRIFT
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:VANDEGRIFT
Last Name:MOHASSEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 CHESWOLDE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3929
Mailing Address - Country:US
Mailing Address - Phone:410-948-7615
Mailing Address - Fax:
Practice Address - Street 1:1475 TANEY AVE STE 201
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-5126
Practice Address - Country:US
Practice Address - Phone:301-662-1930
Practice Address - Fax:240-379-6710
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0073806208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics