Healthcare Provider Details

I. General information

NPI: 1760941538
Provider Name (Legal Business Name): JEANETTE DU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5454 WISCONSIN AVE STE 1700
CHEVY CHASE MD
20815-6951
US

IV. Provider business mailing address

8270 WILLOW OAKS CORPORATE DR
FAIRFAX VA
22031-4530
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-8100
  • Fax: 301-465-3202
Mailing address:
  • Phone:
  • 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 State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD210011553
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: