Provider Demographics
NPI:1699978866
Name:CLOSE, JESSICA DAWN (DO)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:DAWN
Last Name:CLOSE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11110 MEDICAL CAMPUS RD
Mailing Address - Street 2:SUITE 249
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6700
Mailing Address - Country:US
Mailing Address - Phone:301-714-4100
Mailing Address - Fax:301-714-4101
Practice Address - Street 1:11110 MEDICAL CAMPUS RD
Practice Address - Street 2:SUITE 249
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6700
Practice Address - Country:US
Practice Address - Phone:301-714-4100
Practice Address - Fax:301-714-4101
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2012-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV2267207V00000X
MDH0070502207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology