1801038708 NPI number — DR. SHALLIMAR M JONES PHD

Table of content: DR. SHALLIMAR M JONES PHD (NPI 1801038708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801038708 NPI number — DR. SHALLIMAR M JONES PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
SHALLIMAR
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

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:
1801038708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18585 COASTAL HWY
Provider Second Line Business Mailing Address:
UNIT 10 PMB 2021
Provider Business Mailing Address City Name:
REHOBOTH
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19971
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-414-0963
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WALTER REED ARMY MEDICAL CTR
Provider Second Line Business Practice Location Address:
6900 GEORGIA AVENUE, N.W.
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20307-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-706-6678
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2009

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: 103TC0700X , with the licence number:  B1-0000806 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 04495 , 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)