Basic Information
| Provider Information | |||||||||
| NPI: | 1780685073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARMS | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | LYNNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1111 BENFIELD BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MILLERSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211083002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107295100 | ||||||||
| FaxNumber: | 4107295156 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 SHOREWAY DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | QUEENSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216581666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108274001 | ||||||||
| FaxNumber: | 4108274333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 12/05/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D41339 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7605-0019 | 01 | MD | CAREFIRST BLUECHOICE | OTHER | 80083133 | 01 | MD | RR MEDICARE | OTHER | P11955 | 01 | MD | CAREFIRST MPOS | OTHER | 0100065 | 01 | MD | AETNA CAPITATED | OTHER | 760391600 | 05 | MD | MEDICAID | 525795-10 | 01 | MD | CAREFIRST MD RENDERING | OTHER | 4567833 | 01 | MD | AETNA FEE FOR SERVICE | OTHER | 017500 | 01 | MD | JHHC PROVIDER NUMBER | OTHER | 1199485 | 01 | MD | CIGNA PIN | OTHER | 235430 | 01 | MD | MAMSI SPECIALIST | OTHER | 835430 | 01 | MD | MAMSI PRIMARY CARE | OTHER |