Provider Demographics
NPI:1265792873
Name:SKELTON, JACQUELINE ALISSA (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ALISSA
Last Name:SKELTON
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
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Mailing Address - Street 1:PO BOX 62063
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2063
Mailing Address - Country:US
Mailing Address - Phone:410-706-1196
Mailing Address - Fax:410-706-8163
Practice Address - Street 1:3001 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785
Practice Address - Country:US
Practice Address - Phone:410-328-6749
Practice Address - Fax:410-328-7305
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2018-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD85243208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics