Provider Demographics
NPI:1255414371
Name:JANSSEN, JEREMY J (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:J
Last Name:JANSSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7 GRANITE PLACE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-6607
Mailing Address - Country:US
Mailing Address - Phone:240-631-1170
Mailing Address - Fax:240-631-1031
Practice Address - Street 1:7 GRANITE PLACE
Practice Address - Street 2:SUITE 14
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-6607
Practice Address - Country:US
Practice Address - Phone:240-631-1170
Practice Address - Fax:240-631-1031
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2018-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0057305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD807801700Medicaid
MD807801700Medicaid
490816ZAB5Medicare PIN