Healthcare Provider Details

I. General information

NPI: 1306074935
Provider Name (Legal Business Name): JANE GERMANO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 VARNUM ST NE DEPT OF PEDIATRICS
WASHINGTON DC
20017-2104
US

IV. Provider business mailing address

1150 VARNUM ST NE DEPT OF PEDIATRICS
WASHINGTON DC
20017-2104
US

V. Phone/Fax

Practice location:
  • Phone: 202-854-7074
  • Fax: 202-854-7470
Mailing address:
  • Phone: 202-854-7074
  • Fax: 202-854-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO034479
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number267085
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: