Healthcare Provider Details

I. General information

NPI: 1871569483
Provider Name (Legal Business Name): JACK L. FLYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5530 WISCONSIN AVE STE 700
CHEVY CHASE MD
20815-4401
US

IV. Provider business mailing address

5530 WISCONSIN AVE STE 700
CHEVY CHASE MD
20815-4401
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-5050
  • Fax: 301-654-4237
Mailing address:
  • Phone: 301-654-0142
  • Fax: 301-654-4237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0060887
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: