Individual
DR. BERNICE D. JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1160 VARNUM ST NE, SUITE 314, WASHINGTON, DC 20017-2107
(202) 269-9249
(202) 269-9271
Mailing address
15009 NOTLEY RD, SILVER SPRING, MD 20905-7438
(202) 269-9429
(202) 269-9271
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD17118
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
027063100
—
DC
01
—
579232
ALLIANCE
DC
01
—
63833701
BCBS MD
MD
01
—
6631 0001
BC BS DC
DC
01
—
AETNA
2005550
DC
Enumeration date
07/14/2006
Last updated
01/21/2011
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