Healthcare Provider Details

I. General information

NPI: 1477129757
Provider Name (Legal Business Name): JACOB MICHAEL DEAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-0004
US

IV. Provider business mailing address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-5600
US

V. Phone/Fax

Practice location:
  • Phone: 856-776-9174
  • Fax:
Mailing address:
  • Phone: 301-295-8641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0101278707
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: