Jackson, Evelyn Diane

Jackson, Evelyn Diane is an sole proprietor health care provider with primary practice located at 3416 Olandwood Ct Suite 200, Olney MD 20832-1372. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Jackson, Evelyn Diane can be contacted via phone (301) 774-5600.

Contact Information

Primary practice address
3416 Olandwood Ct Suite 200 Olney MD 20832-1372
Phone: (301) 774-5600
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X D25947 Maryland

Profile Details

NPI number 1770707093
LBN Legal business name Jackson, Evelyn Diane
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 11th, 2007
Last updated May 18th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770707093 NPPES
Maryland MEDICAID 25560-1002

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