Provider Demographics
NPI:1083455687
Name:TAKUSI, JEROME
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:TAKUSI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 WHITE MILLS RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-2657
Mailing Address - Country:US
Mailing Address - Phone:301-996-8727
Mailing Address - Fax:
Practice Address - Street 1:3831 PENNSYLVANIA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-1309
Practice Address - Country:US
Practice Address - Phone:202-853-4879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator