Provider Demographics
NPI:1881040277
Name:JACKSON, CHRISTOPHER EZEKIEL (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:EZEKIEL
Last Name:JACKSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 EISENHOWER AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4587
Mailing Address - Country:US
Mailing Address - Phone:301-246-2586
Mailing Address - Fax:
Practice Address - Street 1:2232 E MONUMENT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-2431
Practice Address - Country:US
Practice Address - Phone:667-207-3552
Practice Address - Fax:443-885-9778
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012719552084P0800X
NJ25IA124668002084P0800X
AL500042084P0800X
DCMD2100030602084P0800X
MDD00943542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry