Provider Demographics
NPI:1750347282
Name:JEFFREYS, RONALD D (DO)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:D
Last Name:JEFFREYS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:410-882-3240
Mailing Address - Fax:410-661-5093
Practice Address - Street 1:8800 WALTHER BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-9001
Practice Address - Country:US
Practice Address - Phone:410-882-3240
Practice Address - Fax:410-661-5093
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0052365207R00000X
PAOS023315207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD04-42052OtherEVERCARE
522096682002OtherTRICARE NORTH
093NER-769698-06OtherCAREFIRST BCBS OF MD
093NSE-769698-06OtherCAREFIRST BCBS OF MD
MD805701000Medicaid
9676-0045OtherCAREFIRST BCBS OF DC
MD805701000OtherMEDICAID
MD805701000Medicaid
093NSE-769698-06OtherCAREFIRST BCBS OF MD
MD137489ZBLCMedicare PIN
MD945L - M361Medicare ID - Type Unspecified
MD805701000OtherMEDICAID