Provider Demographics
NPI:1285730762
Name:SIMON, JON E (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:E
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11121 YORK RD
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2006
Mailing Address - Country:US
Mailing Address - Phone:410-628-2026
Mailing Address - Fax:410-667-6834
Practice Address - Street 1:11121 YORK RD
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21030-2006
Practice Address - Country:US
Practice Address - Phone:106-282-0264
Practice Address - Fax:410-667-6834
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD53156208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG86734Medicare UPIN