Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jericho De Mata, DO

Individual provider Family Medicine Physician · NPI 1275950396

Jericho De Mata, DO is an Emergency Medicine in Upper Marlboro, Maryland. Qualified in 2014, 12 years ago. Practices with Kaiser Foundation Health Plan of the Mid Atlantic States, Inc, a 1,934-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in District of Columbia, Maryland and Virginia.

Years since qualifying
12
Licensed in
DC, MD, VA
In the registry since
2014
Specialties on file
3
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

See every abbreviation used in this directory →

Practice location Address checks out

1221 Mercantile Ln
Upper Marlboro, MD 20774-5374
Phone: (301) 618-5500
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2139 Georgia Ave Nw Ste 3b, Washington, DC 20001-3006 — (202) 865-6100

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence H83783 (MD)
Family Medicine Physician Taxonomy 207Q00000X · Licence MD045539 (DC)
Family Medicine Physician Taxonomy 207Q00000X · Licence 0102205000 (VA)

Record details

NPI number1275950396
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedMarch 26, 2014
Last updated in NPPESJune 20, 2021
Certification dateJune 20, 2021
Mailing address2101 E Jefferson St Ste 6w, Rockville, MD 20852-4908

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyEMERGENCY MEDICINE
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Kaiser Foundation Health Plan Of The Mid Atlantic States, Inc — 1934 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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