Provider Demographics
NPI:1285742809
Name:NESBITT, JOHN A III (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:NESBITT
Suffix:III
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 1:6080 FALLS RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2230
Mailing Address - Country:US
Mailing Address - Phone:410-323-2757
Mailing Address - Fax:410-323-2715
Practice Address - Street 1:6080 FALLS RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2230
Practice Address - Country:US
Practice Address - Phone:410-323-2757
Practice Address - Fax:410-323-2715
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD14623207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408111606OtherRAILROAD MEDICARE #
MDT992OtherBLUECHOICE #
MDD73947Medicare UPIN
MD6382JAOtherCAREFIRST MARYLAND #
MD187591400Medicaid
MD6382Medicare PIN