Healthcare Provider Details

I. General information

NPI: 1154215358
Provider Name (Legal Business Name): JARED PINKHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 M ST NW FL 4
WASHINGTON DC
20037-1434
US

IV. Provider business mailing address

850 QUINCY ST NW APT 710
WASHINGTON DC
20011-5879
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-3275
  • Fax:
Mailing address:
  • Phone: 610-405-0405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201002030
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: