Healthcare Provider Details

I. General information

NPI: 1437786993
Provider Name (Legal Business Name): DR. ANDREW JEONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23000 MOAKLEY ST STE 102
LEONARDTOWN MD
20650-2916
US

IV. Provider business mailing address

23000 MOAKLEY ST STE 102
LEONARDTOWN MD
20650-2916
US

V. Phone/Fax

Practice location:
  • Phone: 301-475-5555
  • Fax:
Mailing address:
  • Phone: 301-475-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD0107637
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: