Individual
JERICHO DE MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1221 MERCANTILE LN, UPPER MARLBORO, MD 20774-5374
(301) 618-5500
Mailing address
2101 E JEFFERSON ST STE 6W, ROCKVILLE, MD 20852-4908
(301) 816-5853
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0102205000
VA
207Q00000X
Family Medicine Physician
Primary
H83783
MD
207Q00000X
Family Medicine Physician
MD045539
DC
Other
Enumeration date
03/26/2014
Last updated
06/20/2021
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