Individual
DR. JEFFERY JAWNI DORMU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
8730 CHERRY LANE, SUITE 10, LAUREL, MD 20707
(301) 497-1590
(240) 334-4781
Mailing address
8730 CHERRY LANE, SUITE 10, LAUREL, MD 20707
(301) 497-1590
(240) 334-4781
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
25MB07611900
NJ
208600000X
Surgery Physician
DO034245
DC
208600000X
Surgery Physician
H0065639
MD
2086S0129X
Vascular Surgery Physician
Primary
D0034245
DC
2086S0129X
Vascular Surgery Physician
H0065639
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0048615
—
NJ
05
—
031107300
—
MD
05
—
054737700
—
DC
Enumeration date
10/12/2005
Last updated
07/18/2012
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