Healthcare Provider Details

I. General information

NPI: 1396779385
Provider Name (Legal Business Name): JEFFREY A LAFFERMAN MD/PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 SULPHUR SPRING RD
BALTIMORE MD
21227-2539
US

IV. Provider business mailing address

5016 KEMP RD REISTERSTOWN
REISTERSTOWN MD
21136-4712
US

V. Phone/Fax

Practice location:
  • Phone: 410-242-0920
  • Fax: 410-242-0924
Mailing address:
  • Phone: 410-429-0909
  • Fax: 410-825-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberM21440
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberBL0369656
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD31176
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0031176
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: