Healthcare Provider Details

I. General information

NPI: 1487642872
Provider Name (Legal Business Name): JONATHAN SANDERS PLOTSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15225 SHADY GROVE RD STE 102
ROCKVILLE MD
20850-3254
US

IV. Provider business mailing address

14705 MENTMORE PL
NORTH POTOMAC MD
20878-2577
US

V. Phone/Fax

Practice location:
  • Phone: 301-330-0661
  • Fax: 301-977-6940
Mailing address:
  • Phone: 301-294-1306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0038589
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: