Jericho De Mata, D.O.
Family Medicine in Upper Marlboro, MD. Individual provider (NPI-1).
NPI number1275950396
StatusActive
Last updated in NPPESAug 11, 2026
Details
- NPI
- 1275950396
- Entity type
- Individual (NPI-1)
- Name
- Jericho De Mata
- Credential
- D.O.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 26, 2014
- Certification date
- Aug 11, 2026
- Last updated
- Aug 11, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | H83783 | MD | Yes |
| 207Q00000X | Family Medicine | 0102205000 | VA | |
| 207Q00000X | Family Medicine | MD045539 | DC |
Practice location
1221 Mercantile LnUpper Marlboro, MD 20774-5374
Phone 301-618-5500
Mailing address
2101 E Jefferson St Ste 6wRockville, MD 20852-4908
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