Provider Demographics
NPI:1922060870
Name:JACKSON, MERCY PREETHI (MD)
Entity Type:Individual
Prefix:DR
First Name:MERCY
Middle Name:PREETHI
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MERCY
Other - Middle Name:PREETHI
Other - Last Name:KUMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6740 ALEXANDER BELL DR # 300
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2248
Mailing Address - Country:US
Mailing Address - Phone:410-564-0000
Mailing Address - Fax:410-564-0032
Practice Address - Street 1:6740 ALEXANDER BELL DR STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2248
Practice Address - Country:US
Practice Address - Phone:410-564-0000
Practice Address - Fax:410-564-0032
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063166207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4095448 00Medicaid
MD0018OtherCAREFIRST-DC
MD0018OtherCAREFIRST-DC
MD647984-02OtherCAREFIRST-MD
MDI46830Medicare UPIN