Healthcare Provider Details

I. General information

NPI: 1841295714
Provider Name (Legal Business Name): JEROME M SHIER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

11821 WINTERSET TER
POTOMAC MD
20854-2847
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-2300
  • Fax:
Mailing address:
  • Phone: 301-518-2620
  • Fax: 301-738-9295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberD0033458
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberD33458
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: