Healthcare Provider Details

I. General information

NPI: 1942462064
Provider Name (Legal Business Name): JONATHAN MCCONE JR. MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6196 OXON HILL RD STE 640
OXON HILL MD
20745
US

IV. Provider business mailing address

6196 OXON HILL RD STE 640
OXON HILL MD
20745-3112
US

V. Phone/Fax

Practice location:
  • Phone: 301-567-2400
  • Fax: 301-567-0380
Mailing address:
  • Phone: 703-780-0994
  • Fax: 703-780-0929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number0101030567
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License NumberD20749
License Number StateMD

VIII. Authorized Official

Name: DR. JONATHAN MCCONE JR.
Title or Position: CEO
Credential: MD
Phone: 703-780-1113