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-- PAMELA DAWN RANDOLPH JACKSON -- MD

Individual Provider (NPI-1) Active

Provider Information

NPI Number
1801813407
Provider Type
Individual Provider (NPI-1)
Credentials
MD
Status
Active

Contact & Location

Address
110 IRVING ST NW, WASHINGTON, DC, 20010
Phone
(800) 353-0788
Fax
(804) 355-6031

Specialties & Taxonomies

Unknown Primary License: DC #DC 19357

All Addresses

MAILING

12605 WILLOW MARSH LANE

BOWIE, MD, 20720

(301) 262-1528

LOCATION

110 IRVING ST NW

WASHINGTON, DC, 20010

(800) 353-0788