Healthcare Provider Details

I. General information

NPI: 1265792873
Provider Name (Legal Business Name): JACQUELINE ALISSA SKELTON M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 HOSPITAL DR
CHEVERLY MD
20785
US

IV. Provider business mailing address

PO BOX 62063
BALTIMORE MD
21264-2063
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6749
  • Fax: 410-328-7305
Mailing address:
  • Phone: 410-706-1196
  • Fax: 410-706-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD85243
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberD85243
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: