Healthcare Provider Details

I. General information

NPI: 1538116678
Provider Name (Legal Business Name): RISA JAMPEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 CROSSROADS DR SUITE 325
OWINGS MILLS MD
21117-5441
US

IV. Provider business mailing address

21 CROSSROADS DR SUITE 325
OWINGS MILLS MD
21117-5441
US

V. Phone/Fax

Practice location:
  • Phone: 410-356-0171
  • Fax: 410-356-0172
Mailing address:
  • Phone: 410-356-0171
  • Fax: 410-356-0172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD35193
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: