MEDICARE: JEREMY MIDDLETON

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	1744R1102X	Research Study Specialist

General Provider Information

NPI Number	:	1538757877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY MIDDLETON

Provider Business Mailing Address
First Line	:	10645B ROCKFISH GAP TPKE
Second Line	:
City	:	AFTON
State	:	VA
Zip	:	22920-2325
Country	:	US
Telephone Number	:	540-280-9003
Fax Number	:	800-396-6701

Provider Business Practice Location Address
First Line	:	656 BURR OAK CT
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-6118
Country	:	US
Telephone Number	:	757-387-7051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2021
Last Update Date	:	01/04/2021

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