Provider Demographics
NPI:1396779385
Name:LAFFERMAN, JEFFREY A (MD/PA)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:LAFFERMAN
Suffix:
Gender:M
Credentials:MD/PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 KEMP RD
Mailing Address - Street 2:REISTERSTOWN
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-4712
Mailing Address - Country:US
Mailing Address - Phone:410-429-0909
Mailing Address - Fax:410-825-0757
Practice Address - Street 1:1634 SULPHUR SPRING RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-2539
Practice Address - Country:US
Practice Address - Phone:410-242-0920
Practice Address - Fax:410-242-0924
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM21440173000000X
MDBL0369656173000000X
MDD31176174400000X
MDD00311762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No173000000XOther Service ProvidersLegal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD260021534OtherBALTIMORE COUNTY
MD260050814OtherDC, PG COUNTY
MD281321100Medicaid