1982636601 NPI number — JEFFREY LANDSMAN MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982636601 NPI number — JEFFREY LANDSMAN MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LANDSMAN

Provider First Name:

JEFFREY

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1982636601

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/09/2014

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

5525 RESEARCH PARK DR FL 4

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BALTIMORE

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

21228-4873

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

781-534-7100

Provider Business Mailing Address Fax Number:

781-534-7358

Provider First Line Business Practice Location Address:

8800 WALTHER BLVD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BALTIMORE

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

21234-9001

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

781-534-7100

Provider Business Practice Location Address Fax Number:

781-534-7358

Provider Enumeration Date:

07/06/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  D0053115 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207QG0300X , with the licence number: D0053115 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 093NER-614408-04 . This is a "CAREFIRST BCBS OF MD" identifier . This identifiers is of the category "OTHER".
• Identifier: KG01SE-61440804 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
• Identifier: T016-0022 . This is a "CAREFIRST BCBS OF DC (CCI)" identifier . This identifiers is of the category "OTHER".
• Identifier: 0943ER-614408-05 . This is a "CAREFIRST BCBS OF MD" identifier . This identifiers is of the category "OTHER".
• Identifier: KG01ER-61440804 . This is a "CAREFIRST BCBS OF MD (CCI)" identifier . This identifiers is of the category "OTHER".
• Identifier: P14924 . This is a "BCBS OF MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 008203101 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 093NSE-614408-04 . This is a "CAREFIRST BCBS OF MD" identifier . This identifiers is of the category "OTHER".
• Identifier: 0022 . This is a "BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
• Identifier: 9676-0019 . This is a "CAREFIRST BCBS OF DC" identifier . This identifiers is of the category "OTHER".
• Identifier: 0403088 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 211110100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".