Provider Demographics
NPI:1730395633
Name:JELIN, ANGIE CHILD (MD)
Entity type:Individual
Prefix:DR
First Name:ANGIE
Middle Name:CHILD
Last Name:JELIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:CHILD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6201 GREENLEIGH AVE RM POB 108
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-500-4266
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-955-5850
Practice Address - Fax:410-614-7720
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100032207V00000X
DCMD041383207VM0101X
MDD76826207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN