Provider Demographics
NPI:1386703734
Name:ATKINSON, JEFFREY EARL (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:EARL
Last Name:ATKINSON
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 1:8028 RITCHIE HWY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122
Mailing Address - Country:US
Mailing Address - Phone:410-768-8600
Mailing Address - Fax:410-768-1676
Practice Address - Street 1:8028 RITCHIE HWY
Practice Address - Street 2:SUITE 108
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122
Practice Address - Country:US
Practice Address - Phone:410-768-8600
Practice Address - Fax:410-768-1676
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043303207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
774M341FMedicare ID - Type Unspecified
F40742Medicare UPIN