Healthcare Provider Details

I. General information

NPI: 1295762185
Provider Name (Legal Business Name): DONNA JASPER D.O.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 KUETHE DR
ANNAPOLIS MD
21403-4026
US

IV. Provider business mailing address

119 KUETHE DR
ANNAPOLIS MD
21403-4026
US

V. Phone/Fax

Practice location:
  • Phone: 410-268-3879
  • Fax:
Mailing address:
  • Phone: 410-268-3879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberH0053769
License Number StateMD

VIII. Authorized Official

Name: DONNA LYNNE JASPER
Title or Position: PRESIDENT
Credential: D.O.
Phone: 410-268-3879