1487642872 NPI number — DR. JONATHAN SANDERS PLOTSKY MD

Table of content: DR. JONATHAN SANDERS PLOTSKY MD (NPI 1487642872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487642872 NPI number — DR. JONATHAN SANDERS PLOTSKY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLOTSKY
Provider First Name:
JONATHAN
Provider Middle Name:
SANDERS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487642872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14705 MENTMORE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH POTOMAC
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20878-2577
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-294-1306
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15225 SHADY GROVE RD
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-3254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-330-0661
Provider Business Practice Location Address Fax Number:
301-977-6940
Provider Enumeration Date:
10/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  D0038589 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com