Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | MD046122 | DC |
NPI | 1285900019 |
---|---|
Provider Name | Dr. Jessica Rose Durkee-Shock |
First Address | Bethesda, MD 20814 |
Second Address | Bethesda, MD 20814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2012 |
Last Update Date | 23/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MD046122 | MEDICAL LICENSE (01) | DC |