Search › Maryland › 207Q00000X
Jericho De Mata, D.O
NPI 1275950396 · on the registry since 2014
Practice
- Address
- 1221 Mercantile Ln
Upper Marlboro, MD 20774 - Phone
- (301) 618-5500
- Clinicians at this address
- 81
Additional practice sites
- 2139 Georgia Ave Nw Ste 3b, Washington, DC
Registry record
- Primary taxonomy
- 207Q00000X
207Q00000X
- Also registered as
- 207Q00000X
207Q00000X - Licence states on file
- MD, VA, DC
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2026-08-11
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Maryland