Basic Information
Provider Information
NPI: 1679841183
EntityType: 2
ReplacementNPI:  
OrganizationName: HOSPITALIST MEDICINE PHYSICIANS OF MARYLAND PC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5410 MARYLAND WAY
Address2: SUITE 300
City: BRENTWOOD
State: TN
PostalCode: 370275064
CountryCode: US
TelephoneNumber: 6153775600
FaxNumber: 8882411404
Practice Location
Address1: 5410 MARYLAND WAY
Address2: SUITE 300
City: BRENTWOOD
State: TN
PostalCode: 370275064
CountryCode: US
TelephoneNumber: 6153775600
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/12/2011
LastUpdateDate: 08/16/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: JACOBS
AuthorizedOfficialFirstName: RONNIE
AuthorizedOfficialMiddleName: L
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 6153775658
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


Home