Basic Information
| Provider Information | |||||||||
| NPI: | 1750347282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JEFFREYS | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5525 RESEARCH PARK DR FL 4 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212284873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108823240 | ||||||||
| FaxNumber: | 4106615093 | ||||||||
| Practice Location | |||||||||
| Address1: | 8800 WALTHER BLVD | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212349001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108823240 | ||||||||
| FaxNumber: | 4106615093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2006 | ||||||||
| LastUpdateDate: | 12/09/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | H0052365 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9676-0045 | 01 | CAREFIRST BCBS OF DC | OTHER | 093NSE-769698-06 | 01 | CAREFIRST BCBS OF MD | OTHER | 805701000 | 01 | MD | MEDICAID | OTHER | 04-42052 | 01 | MD | EVERCARE | OTHER | 093NER-769698-06 | 01 | CAREFIRST BCBS OF MD | OTHER | 522096682002 | 01 | TRICARE NORTH | OTHER | 805701000 | 05 | MD | MEDICAID |