Healthcare Provider Details

I. General information

NPI: 1770903478
Provider Name (Legal Business Name): MARISSA KAREN JONES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARISSA KAREN SHIRRON PA

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 CARROLL AVE
TAKOMA PARK MD
20912-6367
US

IV. Provider business mailing address

20010 CENTURY BLVD SUITE 200
GERMANTOWN MD
20874
US

V. Phone/Fax

Practice location:
  • Phone: 240-686-2300
  • Fax: 240-686-2330
Mailing address:
  • Phone: 240-686-2300
  • Fax: 240-780-7899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0005319
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0005319
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: