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General NPI Number Information
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NPI Number | 1396087847
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Entity Type | Individual
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Provider Name | JASON KYLE FEDERLINE D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2013
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 10210 REISTERSTOWN RD
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City | OWINGS MILLS
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State | MD
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Zip | 21117-3606
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Country | US
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Telephone | 410-902-6776
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Fax |
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Provider Business Mailing Address
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Address Line | 111 W HIGH ST STE 314
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City | ELKTON
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State | MD
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Zip | 21921-8617
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H0084148
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License Number State | MD
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