Individual
JEFFREY PETER INDRISANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6410 ROCKLEDGE DR, SUITE 401, BETHESDA, MD 20817-1809
(301) 890-5001
(301) 890-5193
Mailing address
9600 PULASKI PARK DR, 103, BALTIMORE, MD 21220-1400
(443) 725-8762
(410) 780-8790
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
D0037975
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D0037975
STATE LICENSE NUMBER
MD
Enumeration date
06/22/2006
Last updated
03/07/2023
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