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Individual

DR. DAVID SPENCER JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
11055 LITTLE PATUXENT PKWY, SUITE 205, COLUMBIA, MD 21044-2896
(410) 740-0789
(410) 740-7024
Mailing address
7580 BUCKINGHAM BLVD STE 220, HANOVER, MD 21076-3210
(410) 729-5100

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
D35217
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0149212
CIGNA PIN
MD
01
018410
JHHC PROVIDER NUMBER
MD
01
0477972
AETNA CAPITATED
MD
01
060041579
RR MEDICARE
MD
01
318934
MAMSI SPECIALIST
MD
01
3509-0006
CAREFIRST BLUECHOICE
MD
01
398140-03
CAREFIRST MD RENDERING
MD
01
4238639
AETNA FEE FOR SERVICE
MD
05
478471500
MD
01
P528953
CAREFIRST MPOS
MD
Enumeration date
08/10/2005
Last updated
08/22/2019
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