Healthcare Provider Details

I. General information

NPI: 1174826671
Provider Name (Legal Business Name): ALLAN D. JENSEN M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 33RD ST SUITE 426
BALTIMORE MD
21218-3322
US

IV. Provider business mailing address

200 E 33RD ST SUITE 426
BALTIMORE MD
21218-3322
US

V. Phone/Fax

Practice location:
  • Phone: 410-235-1133
  • Fax:
Mailing address:
  • Phone: 410-235-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALLAN D JENSEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-235-1133