MEDICARE: JEFFREY DUNMAN MEWBORNE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085N0700X	Neuroradiology Physician	9601003	NC
2	2085N0700X	Neuroradiology Physician	D96853	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1141E	OTHER	NC	BCBSNC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255313136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY DUNMAN MEWBORNE MD

Provider Business Mailing Address
First Line	:	6201 GREENLEIGH AVE
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-2004
Country	:	US
Telephone Number	:	109-336-4234
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 N WOLFE STREET
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-5758
Country	:	US
Telephone Number	:	410-955-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	06/28/2023

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Directions to “ JEFFREY DUNMAN MEWBORNE MD” Practice Location

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