Provider Demographics
NPI:1942462064
Name:JONATHAN MCCONE JR. MD PC
Entity Type:Organization
Organization Name:JONATHAN MCCONE JR. MD PC
Other - Org Name:MCCONE MT VERNON ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:703-780-1113
Mailing Address - Street 1:6196 OXON HILL RD STE 640
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3112
Mailing Address - Country:US
Mailing Address - Phone:703-780-0994
Mailing Address - Fax:703-780-0929
Practice Address - Street 1:6196 OXON HILL RD STE 640
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745
Practice Address - Country:US
Practice Address - Phone:301-567-2400
Practice Address - Fax:301-567-0380
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. JONATHAN MCCONE JR. MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-30
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030567261QE0800X
MDD20749261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC309161Medicare PIN