Healthcare Provider Details

I. General information

NPI: 1023927365
Provider Name (Legal Business Name): MR. JONATHAN MITCHELL PAYNE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 ADMIRAL COCHRANE DR STE 225
ANNAPOLIS MD
21401-7583
US

IV. Provider business mailing address

51 W WASHINGTON ST APT 3D
HAGERSTOWN MD
21740-4833
US

V. Phone/Fax

Practice location:
  • Phone: 443-440-5780
  • Fax:
Mailing address:
  • Phone: 215-200-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number33344
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: