MEDICARE: JRL AND ASSOCIATES

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician
2	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1801139605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JRL AND ASSOCIATES

Provider Business Mailing Address
First Line	:	205 RIDGELY AVE
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-1303
Country	:	US
Telephone Number	:	410-263-6910
Fax Number	:	410-263-2406

Provider Business Practice Location Address
First Line	:	205 RIDGELY AVE
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-1303
Country	:	US
Telephone Number	:	410-263-6910
Fax Number	:	410-263-2406

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	PATTY SMITH
Credential	:
Telephone Number	:	410-263-6910

Provider Enumeration Date	:	03/29/2013
Last Update Date	:	03/29/2013

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