Healthcare Provider Details

I. General information

NPI: 1285860486
Provider Name (Legal Business Name): JESSICA DANIELLE KORMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 K ST NW T-110
WASHINGTON DC
20006-1003
US

IV. Provider business mailing address

10770 COLUMBIA PIKE STE 400
SILVER SPRING MD
20901-4462
US

V. Phone/Fax

Practice location:
  • Phone: 202-296-3449
  • Fax:
Mailing address:
  • Phone: 240-485-5210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0071994
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD039757
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: