Healthcare Provider Details

I. General information

NPI: 1518313063
Provider Name (Legal Business Name): JONATHAN NATHANIEL PERKINS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF OTOLARYNGOLOGY 8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

DEPARTMENT OF OTOLARYNGOLOGY 8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4664
  • Fax:
Mailing address:
  • Phone: 301-295-4664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberOP60766695
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberOP60766695
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: