Healthcare Provider Details

I. General information

NPI: 1831166487
Provider Name (Legal Business Name): JACQUELYN B. DUNMORE-GRIFFITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8116 GOOD LUCK RD STE LL05
LANHAM MD
20706-3502
US

IV. Provider business mailing address

PO BOX 418837
BOSTON MA
02241-8837
US

V. Phone/Fax

Practice location:
  • Phone: 240-542-3060
  • Fax: 240-542-3061
Mailing address:
  • Phone: 240-542-3060
  • Fax: 240-542-3061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD20575
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberD0046901
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: