Individual
JANE E JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3512 SANDY CT, KENSINGTON, MD 20895-1420
(301) 466-2562
(301) 949-9666
Mailing address
3513 SANDY CT, KENSINGTON, MD 20895-1420
(301) 466-2562
(301) 949-9666
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
D0028973
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
343BJE
CAREFIRST BCBS
MD
01
—
K1240001
CAREFIRST BCBS
DC
01
—
MAMSI MAPSI
385639
—
Enumeration date
05/17/2007
Last updated
07/09/2007
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