Provider Demographics
NPI:1366272155
Name:ANDERSON, JAMEEL (DNP)
Entity type:Individual
Prefix:
First Name:JAMEEL
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 SEAMASTER RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-5962
Mailing Address - Country:US
Mailing Address - Phone:410-274-2416
Mailing Address - Fax:
Practice Address - Street 1:5890 WATERLOO RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2617
Practice Address - Country:US
Practice Address - Phone:667-214-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR213800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily