MEDICARE: JACKIE SYME MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	D0044476	MD

General Provider Information

NPI Number	:	1760476105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKIE SYME MD

Provider Business Mailing Address
First Line	:	PO BOX 64023
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-4023
Country	:	US
Telephone Number	:	410-280-6577
Fax Number	:	410-280-6515

Provider Business Practice Location Address
First Line	:	2401 BRANDERMILL BLVD
Second Line	:	SITE 301
City	:	GAMBRILLS
State	:	MD
Zip	:	21054-1690
Country	:	US
Telephone Number	:	410-451-9064
Fax Number	:	410-451-9065

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	03/06/2008

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Directions to “ JACKIE SYME MD” Practice Location

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