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General NPI Number Information
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NPI Number | 1750548657
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Entity Type | Organization
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Legal Business Name | BERNICE D JACKSON MD CARDIOLOGY SERVICES, PLLC
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 1160 VARNUM ST NE SUITE 314
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City | WASHINGTON
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State | DC
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Zip | 20017-2107
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Country | US
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Telephone | 202-269-9249
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Fax | 202-269-9271
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Provider Business Mailing Address
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Address Line | 1160 VARNUM ST NE SUITE 314
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City | WASHINGTON
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State | DC
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Zip | 20017-2107
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Country | US
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Telephone | 202-269-9249
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Fax | 202-269-9271
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BERNICE D. JACKSON
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Credential | MD
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Telephone | 202-269-9249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD17118
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License Number State | DC
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