Healthcare Provider Details

I. General information

NPI: 1194304550
Provider Name (Legal Business Name): JASMINE NICOLE GENTRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 POINT LOOKOUT RD
LEONARDTOWN MD
20650-2015
US

IV. Provider business mailing address

25500 POINT LOOKOUT RD
LEONARDTOWN MD
20650-2015
US

V. Phone/Fax

Practice location:
  • Phone: 301-475-6110
  • Fax:
Mailing address:
  • Phone: 301-475-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD500003213
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0100336
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: