Healthcare Provider Details

I. General information

NPI: 1841618113
Provider Name (Legal Business Name): VANESSA OZOMARO JEFFRIES M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA NGOZI OZOMARO MD

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S CATON AVE
BALTIMORE MD
21229-5201
US

IV. Provider business mailing address

900 S CATON AVE
BALTIMORE MD
21229-5201
US

V. Phone/Fax

Practice location:
  • Phone: 651-368-2500
  • Fax:
Mailing address:
  • Phone: 651-368-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD83362
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: