Provider Demographics
NPI:1366431801
Name:YOSPIN, JEREMY ROSS (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:ROSS
Last Name:YOSPIN
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 1:12931 OAK HILL AVENUE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2914
Mailing Address - Country:US
Mailing Address - Phone:301-797-9600
Mailing Address - Fax:301-797-3854
Practice Address - Street 1:12931 OAK HILL AVENUE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2914
Practice Address - Country:US
Practice Address - Phone:301-797-9600
Practice Address - Fax:301-797-3854
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060469207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810011186Medicaid
PA1018921100001Medicaid
MD404957800Medicaid
PA1018921100001Medicaid
PA108213RAXMedicare PIN
MDH90860Medicare UPIN
MD404957800Medicaid