Healthcare Provider Details

I. General information

NPI: 1982636601
Provider Name (Legal Business Name): JEFFREY LANDSMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 WALTHER BLVD
BALTIMORE MD
21234-9001
US

IV. Provider business mailing address

5525 RESEARCH PARK DR FL 4
BALTIMORE MD
21228-4873
US

V. Phone/Fax

Practice location:
  • Phone: 781-534-7100
  • Fax: 781-534-7358
Mailing address:
  • Phone: 781-534-7100
  • Fax: 781-534-7358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0053115
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberD0053115
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: