MEDICARE: JEFFREY SOULEN M.D.

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	2084P0800X	Psychiatry Physician	D39080	MD

General Provider Information

NPI Number	:	1285617506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY SOULEN M.D.

Provider Business Mailing Address
First Line	:	2833 MONTCLAIR DR
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-3423
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3355 SAINT JOHNS LN
Second Line	:	STE F
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2605
Country	:	US
Telephone Number	:	410-465-2056
Fax Number	:	667-401-6143

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	02/18/2016

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