MEDICARE: JEREMY J. JANSSEN, M.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D0057305	MD

General Provider Information

NPI Number	:	1891826392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEREMY J. JANSSEN, M.D., P.C.

Provider Business Mailing Address
First Line	:	11908 DARNESTOWN RD
Second Line	:	SUITE C
City	:	NORTH POTOMAC
State	:	MD
Zip	:	20878-2295
Country	:	US
Telephone Number	:	240-631-1170
Fax Number	:	240-631-1031

Provider Business Practice Location Address
First Line	:	11908 DARNESTOWN RD
Second Line	:	SUITE C
City	:	NORTH POTOMAC
State	:	MD
Zip	:	20878-2295
Country	:	US
Telephone Number	:	240-631-1170
Fax Number	:	240-631-1031

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEREMY JAMES JANSSEN
Credential	:	M.D.
Telephone Number	:	240-631-1170

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	10/16/2008

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