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General NPI Number Information
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NPI Number | 1538372826
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Entity Type | Organization
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Legal Business Name | JALLER FAMILY MEDICINE, PC
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 184 THOMAS JOHNSON DR STE 200
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City | FREDERICK
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State | MD
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Zip | 21702-4561
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Country | US
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Telephone | 301-624-5544
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Fax | 301-624-4164
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Provider Business Mailing Address
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Address Line | 4805 TALLAHASSEE AVE
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City | ROCKVILLE
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State | MD
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Zip | 20853-3144
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Country | US
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Telephone | 301-942-9773
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Fax | 888-428-2275
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID JALLER
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Credential | M.D.
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Telephone | 301-624-5544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D0033153
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License Number State | MD
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