MEDICARE: F DANIEL JACKSON, MD, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1174532238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	F DANIEL JACKSON, MD, PA

Provider Business Mailing Address
First Line	:	PO BOX 1692
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21501-1692
Country	:	US
Telephone Number	:	301-759-3817
Fax Number	:	301-759-3286

Provider Business Practice Location Address
First Line	:	130 PENNSYLVANIA AVE
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-4236
Country	:	US
Telephone Number	:	301-759-2666
Fax Number	:	301-759-2841

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. F DANIEL JACKSON
Credential	:	M.D.
Telephone Number	:	301-759-3817

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	08/22/2020

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