Active NPI
Dianne Regina Jackson, M.D.
- General Practice Physician
- Owings Mills, MD
National Provider Identifier
1003193947
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- D0039496
- Practice address
- 9601 Reistertown Rd
Owings Mills, MD 21117 - Phone
- (301) 352-9763
- NPI assigned
- Nov 7, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | D0039496 | MD | Primary |
Addresses
Primary practice location
9601 Reistertown Rd
Owings Mills, MD 21117
Mailing address
P.O. Box (561)
Lanham, MD 20703
Phone (301) 352-9763
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0039496 | MD | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320624000000",
"number": "1003193947",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX (561)",
"city": "LANHAM",
"state": "MD",
"postal_code": "20703",
"telephone_number": "301-352-9763"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9601 REISTERTOWN RD",
"city": "OWINGS MILLS",
"state": "MD",
"postal_code": "21117",
"telephone_number": "301-352-9763"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DIANNE",
"middle_name": "REGINA",
"name_prefix": "Ms.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-07",
"last_updated": "2011-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MD",
"license": "D0039496",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Owings Mills, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.