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Individual

JESSICA DERRETH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
601 N CAROLINE ST, BALTIMORE, MD 21287-0006
(443) 997-9466
Mailing address
5100 WHITEFORD AVE, BALTIMORE, MD 21212-4108

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C06975
MD

Other

Enumeration date
02/26/2019
Last updated
02/26/2019
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