Provider Demographics
NPI:1306548136
Name:WASHINGTON, JEROME ORDELLE
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:ORDELLE
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JEROME
Other - Middle Name:ORDELLE
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11762 NATIONALS LN
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3275
Mailing Address - Country:US
Mailing Address - Phone:646-821-6180
Mailing Address - Fax:
Practice Address - Street 1:6323 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1101
Practice Address - Country:US
Practice Address - Phone:202-525-3954
Practice Address - Fax:202-450-5110
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator