Healthcare Provider Details

I. General information

NPI: 1891742953
Provider Name (Legal Business Name): JESSE M PINES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 02/16/2025
Certification Date: 02/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 23RD ST NW
WASHINGTON DC
20037-2342
US

IV. Provider business mailing address

2424 N POTOMAC ST
ARLINGTON VA
22207-1026
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-2911
  • Fax:
Mailing address:
  • Phone: 202-577-5084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD038463
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number0101279488
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD424508
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: