Healthcare Provider Details

I. General information

NPI: 1891826392
Provider Name (Legal Business Name): JEREMY J. JANSSEN, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 GRANITE PL STE 14
GAITHERSBURG MD
20878-6607
US

IV. Provider business mailing address

7 GRANITE PL STE 14
GAITHERSBURG MD
20878-6607
US

V. Phone/Fax

Practice location:
  • Phone: 240-631-1170
  • Fax: 240-631-1031
Mailing address:
  • Phone: 240-631-1170
  • Fax: 240-631-1031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0057305
License Number StateMD

VIII. Authorized Official

Name: DR. JEREMY JAMES JANSSEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 240-631-1170