Healthcare Provider Details

I. General information

NPI: 1306038088
Provider Name (Legal Business Name): MARCEE' JACKSON WHITE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCEE' CHRISTINA JACKSON M.D.

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 DIVISION ST
BALTIMORE MD
21217-3121
US

IV. Provider business mailing address

6704 CHAPEL DALE RD
BOWIE MD
20720-5217
US

V. Phone/Fax

Practice location:
  • Phone: 410-383-8300
  • Fax: 410-383-3160
Mailing address:
  • Phone: 202-302-4699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD036874
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: