Healthcare Provider Details

I. General information

NPI: 1871573147
Provider Name (Legal Business Name): JEFFREY R. LIMJUCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-0004
US

IV. Provider business mailing address

10027 DALLAS AVE
SILVER SPRING MD
20901-2240
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4941
  • Fax:
Mailing address:
  • Phone: 301-957-0651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.120038
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0096070
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: