Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | C0008195 | MD |
NPI | 1003578899 |
---|---|
Provider Name | Jessica Pryor |
First Address | Washington, DC 20008-5301 |
Second Address | Glenn Dale, MD 20769-9183 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2021 |
Last Update Date | 08/10/2021 |