Healthcare Provider Details

I. General information

NPI: 1144920893
Provider Name (Legal Business Name): JAKE CRESTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED NATIONAL MILITARY MEDICAL CENTER
BETHESDA MD
20889-0004
US

IV. Provider business mailing address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-0004
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-8754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101283177
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: