Provider Demographics
NPI:1992477137
Name:REDENBAUGH, JEFFERY JOSEPH (PA-C)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:JOSEPH
Last Name:REDENBAUGH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 OLD PADONIA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-4944
Mailing Address - Country:US
Mailing Address - Phone:410-825-4530
Mailing Address - Fax:410-825-3787
Practice Address - Street 1:1212 YORK RD STE B201
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6242
Practice Address - Country:US
Practice Address - Phone:410-824-3787
Practice Address - Fax:410-825-3787
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC00081842086S0129X
363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant