Individual
JOSE MA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4853 PULASKI HWY, STE 300, PERRYVILLE, MD 21903-1606
(410) 642-2289
Mailing address
210 CHESAPEAKE BLVD, ELKTON, MD 21921-6395
(410) 620-0545
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0044716
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142661300
—
MD
01
—
K729U499
MEDICARE
MD
Enumeration date
05/31/2006
Last updated
02/17/2016
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