Healthcare Provider Details

I. General information

NPI: 1326023326
Provider Name (Legal Business Name): ALLAN DAVID JENSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EAST 33RD ST SUITE 426
BALTIMORE MD
21218-3381
US

IV. Provider business mailing address

200 EAST 33RD ST SUITE 426
BALTIMORE MD
21218-3381
US

V. Phone/Fax

Practice location:
  • Phone: 410-235-1133
  • Fax: 410-235-1267
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD8901
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: