Healthcare Provider Details

I. General information

NPI: 1679532071
Provider Name (Legal Business Name): JEFFREY M CHINSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CATON AVENUE
BALTIMORE MD
21229
US

IV. Provider business mailing address

PO BOX 64316
BALTIMORE MD
21264-4316
US

V. Phone/Fax

Practice location:
  • Phone: 410-368-2516
  • Fax: 410-368-3549
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0040309
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: