Healthcare Provider Details

I. General information

NPI: 1285730762
Provider Name (Legal Business Name): JON E SIMON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11121 YORK RD
HUNT VALLEY MD
21030-2006
US

IV. Provider business mailing address

11121 YORK RD
HUNT VALLEY MD
21030-2006
US

V. Phone/Fax

Practice location:
  • Phone: 106-282-0264
  • Fax: 410-667-6834
Mailing address:
  • Phone: 410-628-2026
  • Fax: 410-667-6834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD53156
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD53156
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: