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General NPI Number Information
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NPI Number | 1659303238
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Entity Type | Individual
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Provider Name | MONICA ANDREA JESSUP DPM
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Gender | Female
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 8901 WISCONSIN AVE
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City | BETHESDA
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State | MD
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Zip | 20889-1337
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Country | US
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Telephone | 301-295-4320
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Fax |
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Provider Business Mailing Address
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Address Line | 8901 WISCONSIN AVE
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City | BETHESDA
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State | MD
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Zip | 20889-0004
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Country | US
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Telephone |
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Fax |
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 548
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 451
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License Number State | NC
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