Healthcare Provider Details

I. General information

NPI: 1720010333
Provider Name (Legal Business Name): JOHN KIJAK JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9815 MAIN ST SUITE 41
DAMASCUS MD
20872-2002
US

IV. Provider business mailing address

9815 MAIN ST SUITE 41
DAMASCUS MD
20872-2002
US

V. Phone/Fax

Practice location:
  • Phone: 301-253-4004
  • Fax: 301-253-3391
Mailing address:
  • Phone: 301-253-4004
  • Fax: 301-253-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA PHELPS HANAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 301-253-4004