Healthcare Provider Details

I. General information

NPI: 1518460252
Provider Name (Legal Business Name): JARED MICHAEL EGBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1546 PORTER ST
FORT DETRICK MD
21702-9234
US

IV. Provider business mailing address

1546 PORTER ST
FORT DETRICK MD
21702-9234
US

V. Phone/Fax

Practice location:
  • Phone: 301-619-4067
  • Fax:
Mailing address:
  • Phone: 301-619-4067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number31947
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number31947
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: