Provider Demographics
NPI:1396143210
Name:JESSE SADIKMAN, MD, LLC
Entity type:Organization
Organization Name:JESSE SADIKMAN, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SADIKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-793-5574
Mailing Address - Street 1:121 CONGRESSIONAL LN
Mailing Address - Street 2:SUITE 402
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1542
Mailing Address - Country:US
Mailing Address - Phone:240-793-5574
Mailing Address - Fax:
Practice Address - Street 1:121 CONGRESSIONAL LN
Practice Address - Street 2:SUITE 402
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1542
Practice Address - Country:US
Practice Address - Phone:240-793-5574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty