| Jackson Family Medicine, Llc | |
|
10 Saint Patricks Dr #502 Waldorf MD 20603-4527 | |
| (301) 885-3350 | |
| (301) 885-0061 |
| Full Name | Jackson Family Medicine, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10 Saint Patricks Dr, Waldorf, Maryland |
| Authorized Official Name and Position | Dainty J Jackson (DOCTOR) |
| Authorized Official Contact | 3018853350 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Family Medicine, Llc Po Box 7876 Upper Marlboro MD 20792-7876 Ph: (301) 885-3350 | Jackson Family Medicine, Llc 10 Saint Patricks Dr #502 Waldorf MD 20603-4527 Ph: (301) 885-3350 |
| NPI Number | 1780825224 |
|---|---|
| Provider Enumeration Date | 03/12/2009 |
| Last Update Date | 03/12/2009 |
| Medicare PECOS PAC ID | 7810054798 |
|---|---|
| Medicare Enrollment ID | O20090319000543 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780825224 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | H0058218 (Maryland) | Primary |
| Provider Name | Dainty J Jackson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194765834 PECOS PAC ID: 3375600257 Enrollment ID: I20090319000526 |
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