Healthcare Provider Details

I. General information

NPI: 1679809230
Provider Name (Legal Business Name): JASON SCHALLHEIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 10/25/2025
Certification Date: 10/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PKWY DEPARTMENT OF PATHOLOGY
ANNAPOLIS MD
21401-3773
US

IV. Provider business mailing address

36 EMERSON RD
SEVERNA PARK MD
21146-3037
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-4254
  • Fax: 601-984-1531
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberMD157630
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number23468
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD157630
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberD0082520
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: