Provider Demographics
NPI:1063569978
Name:JACKSON, MARGARETIA L (MD)
Entity type:Individual
Prefix:DR
First Name:MARGARETIA
Middle Name:L
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4910 MASSACHUSETTS AVE NW
Mailing Address - Street 2:SUITE 217
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4300
Mailing Address - Country:US
Mailing Address - Phone:202-244-1553
Mailing Address - Fax:202-244-2192
Practice Address - Street 1:4910 MASSACHUSETTS AVE NW
Practice Address - Street 2:SUITE 217
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4300
Practice Address - Country:US
Practice Address - Phone:202-244-1553
Practice Address - Fax:202-244-2192
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD11131208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMD11131OtherMEDICAL LICENSE