Healthcare Provider Details

I. General information

NPI: 1255727764
Provider Name (Legal Business Name): JOHN JUBAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 10/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 ST. PAUL PLACE MERCY MEDICAL CENTER, BUNTING BUILDING, 7TH FLOOR
BALTIMORE MD
21202
US

IV. Provider business mailing address

601 N CAROLINE ST MERCY MEDICAL CENTER, BUNTING BUILDING, 7TH FLOOR
BALTIMORE MD
21287-0006
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9694
  • Fax:
Mailing address:
  • Phone: 410-332-9694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD87554
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberD87554
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: