Individual
PAMELA DAWN RANDOLPH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
110 IRVING ST NW, WASHINGTON, DC 20010
(800) 353-0788
(804) 355-6031
Mailing address
12605 WILLOW MARSH LANE, BOWIE, MD 20720
(301) 262-1528
(804) 355-6031
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
DC 19357
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010150469
—
VA
Enumeration date
07/17/2006
Last updated
12/23/2011
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