Basic Information
| Provider Information | |||||||||
| NPI: | 1801823703 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SABLOFF | ||||||||
| FirstName: | JEFFEREY | ||||||||
| MiddleName: | DENNIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8926 WOODYARD ROAD | ||||||||
| Address2: | SUITE 701 | ||||||||
| City: | CLINTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018561682 | ||||||||
| FaxNumber: | 3018560964 | ||||||||
| Practice Location | |||||||||
| Address1: | 8926 WOODYARD ROAD | ||||||||
| Address2: | SUITE 701 | ||||||||
| City: | CLINTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018561682 | ||||||||
| FaxNumber: | 3018560964 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 05/22/2019 | ||||||||
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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 | 207X00000X | MD9064 | DC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 01010248450 | VA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | D0017653 | MD | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00661248 | 01 | RAILROAD MEDICARE PTAN | OTHER | 40073 | 01 | MDIPA/OPT CHOICE/MAMSI # | OTHER | 420227 | 01 | MD | CAREFIRST OF MARYLAND | OTHER | 778483 | 01 | UNITED HEALTHCARE PROV# | OTHER | 46950002 | 01 | DC | CAREFIRST NCA PROV# | OTHER |