Individual
DEBORAH ANTHONY JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11890 HEALING WAY, SILVER SPRING, MD 20904-7917
(240) 637-4000
Mailing address
11013 LAKE VICTORIA LN, BOWIE, MD 20720-4272
(240) 281-9613
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D0097198
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2020
Last updated
06/18/2023
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