Healthcare Provider Details

I. General information

NPI: 1174502595
Provider Name (Legal Business Name): CRAIG ARTHUR JESCHKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 ALTAMONT PLACE SUITE 201
WHITE PLAINS MD
20695
US

IV. Provider business mailing address

3100 WYMAN PARK DR
BALTIMORE MD
21211-2803
US

V. Phone/Fax

Practice location:
  • Phone: 240-607-1500
  • Fax: 240-607-1510
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0026010
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: