Provider Demographics
NPI:1487813358
Name:JEROME S PLASSE MD PA
Entity type:Organization
Organization Name:JEROME S PLASSE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:PLASSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:410-363-3767
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:10085 RED RUN BLVD #405
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117
Mailing Address - Country:US
Mailing Address - Phone:410-363-3767
Mailing Address - Fax:410-363-0911
Practice Address - Street 1:10085 RED RUN BLVD #405
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117
Practice Address - Country:US
Practice Address - Phone:410-363-3767
Practice Address - Fax:410-363-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00095762086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC57476Medicare UPIN