Basic Information
| Provider Information | |||||||||
| NPI: | 1053382796 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PINESS | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26005 RIDGE ROAD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | DAMASCUS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208721899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014142300 | ||||||||
| FaxNumber: | 3014142306 | ||||||||
| Practice Location | |||||||||
| Address1: | 26005 RIDGE ROAD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | DAMASCUS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208721899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014142300 | ||||||||
| FaxNumber: | 3014142306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2006 | ||||||||
| LastUpdateDate: | 08/27/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 0101045298 | VA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | D0078671 | MD | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 841020800 | 05 | MD | MEDICAID |