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General NPI Number Information
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NPI Number | 1558510909
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Entity Type | Individual
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Provider Name | THERESA DONOHUE JERUSSI MS, PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 04/02/2012
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Provider Practice Location Address
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Address Line | 10 CENTER DRIVE MSC 1202 BUILDING 10, CRC RM 3-5272
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City | BETHESDA
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State | MD
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Zip | 20892-0001
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Country | US
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Telephone | 301-594-8003
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Fax | 301-480-0195
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Provider Business Mailing Address
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Address Line | 10 CENTER DRIVE MSC 1202 BUILDING 10, CRC RM 3-5272
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City | BETHESDA
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State | MD
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Zip | 20892-0001
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Country | US
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Telephone | 301-594-8003
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Fax | 301-480-0195
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0002298
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License Number State | MD
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