Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 0102204185 | VA |
N | 207QS0010X | Family Doctor - Sports Medicine | H0076278 | MD |
NPI | 1104080050 |
---|---|
Provider Name | Jessica Wertz |
First Address | Westminster, MD 21157-6664 |
Second Address | Fairfax, VA 22031-4625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2008 |
Last Update Date | 22/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
068733200 | (05) | MD |