Provider Demographics
NPI:1053488841
Name:NOLD, JEFFREY T (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:T
Last Name:NOLD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2568A RIVA RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7445
Mailing Address - Country:US
Mailing Address - Phone:410-224-7667
Mailing Address - Fax:410-573-4926
Practice Address - Street 1:2024 WEST ST STE 400
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3552
Practice Address - Country:US
Practice Address - Phone:410-224-7667
Practice Address - Fax:410-573-4926
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH00445382080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG18806Medicare UPIN