1902636947 NPI number — JERI PRICE

Table of content: JERI PRICE (NPI 1902636947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902636947 NPI number — JERI PRICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRICE
Provider First Name:
JERI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRICE
Provider Other First Name:
JERI
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LGPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1902636947
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8307 TELEGRAPH RD APT 386
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ODENTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21113-1377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-957-1391
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4404 QUEENSNSBURY ROAD
Provider Second Line Business Practice Location Address:
UNIT 210
Provider Business Practice Location Address City Name:
RIVERDALE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-851-5828
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2024

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: 101YM0800X , with the licence number:  LGPC167000 , 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)