Healthcare Provider Details

I. General information

NPI: 1619661329
Provider Name (Legal Business Name): JESSICA VASANTHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 UNIVERSITY BLVD E
SILVER SPRING MD
20901-2436
US

IV. Provider business mailing address

20 UNIVERSITY BLVD E
SILVER SPRING MD
20901-2436
US

V. Phone/Fax

Practice location:
  • Phone: 301-273-2121
  • Fax:
Mailing address:
  • Phone: 301-273-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0108197
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: