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NPI Code Detail

MEDICARE: JOHN KIJAK JR MD PA

MEDICARE: JOHN KIJAK JR 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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1720010333
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOHN KIJAK JR MD PA
Provider Business Mailing Address
First Line : 9815 MAIN ST
Second Line : SUITE 41
City : DAMASCUS
State : MD
Zip : 20872-2002
Country : US
Telephone Number : 301-253-4004
Fax Number : 301-253-3391
Provider Business Practice Location Address
First Line : 9815 MAIN ST
Second Line : SUITE 41
City : DAMASCUS
State : MD
Zip : 20872-2002
Country : US
Telephone Number : 301-253-4004
Fax Number : 301-253-3391
Authorized Official
Title or Position : OFFICE MANAGER
Name : LINDA PHELPS HANAN
Credential :
Telephone Number : 301-253-4004
Provider Enumeration Date : 07/06/2006
Last Update Date : 08/22/2020

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