Basic Information
| Provider Information | |||||||||
| NPI: | 1174968077 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JEPSON | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | M.D., M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 86 THOMAS JOHNSON CT | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217024348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016948311 | ||||||||
| FaxNumber: | 3016943537 | ||||||||
| Practice Location | |||||||||
| Address1: | 86 THOMAS JOHNSON CT | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016948311 | ||||||||
| FaxNumber: | 3016943537 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2013 | ||||||||
| LastUpdateDate: | 06/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 40570 | SC | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS0010X | D85499 | MD | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207Q00000X | D85499 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.