Provider Demographics
NPI:1891826392
Name:JEREMY J. JANSSEN, M.D., P.C.
Entity Type:Organization
Organization Name:JEREMY J. JANSSEN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:JANSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-631-1170
Mailing Address - Street 1:11908 DARNESTOWN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2295
Mailing Address - Country:US
Mailing Address - Phone:240-631-1170
Mailing Address - Fax:240-631-1031
Practice Address - Street 1:11908 DARNESTOWN RD
Practice Address - Street 2:SUITE C
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-2295
Practice Address - Country:US
Practice Address - Phone:240-631-1170
Practice Address - Fax:240-631-1031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
129512Medicare PIN