Basic Information
| Provider Information | |||||||||
| NPI: | 1396779385 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAFFERMAN | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD/PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5016 KEMP RD | ||||||||
| Address2: | REISTERSTOWN | ||||||||
| City: | REISTERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211364712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104290909 | ||||||||
| FaxNumber: | 4108250757 | ||||||||
| Practice Location | |||||||||
| Address1: | 1634 SULPHUR SPRING RD | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212272539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102420920 | ||||||||
| FaxNumber: | 4102420924 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 09/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173000000X | M21440 | MD | N | Other Service Providers | Legal Medicine | 173000000X | BL0369656 | MD | N | Other Service Providers | Legal Medicine | 174400000X | D31176 | MD | N | Other Service Providers | Specialist | 2084P0800X | D0031176 | MD | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 260021534 | 01 | MD | BALTIMORE COUNTY | OTHER | 260050814 | 01 | MD | DC, PG COUNTY | OTHER | 281321100 | 05 | MD | MEDICAID |