Provider Demographics
NPI:1063659175
Name:JACOB TENDLER, M.D., P.A.
Entity Type:Organization
Organization Name:JACOB TENDLER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:TENDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-337-6800
Mailing Address - Street 1:120 SISTER PIERRE DR
Mailing Address - Street 2:SUITE 501
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7527
Mailing Address - Country:US
Mailing Address - Phone:410-337-6800
Mailing Address - Fax:410-337-8686
Practice Address - Street 1:120 SISTER PIERRE DR
Practice Address - Street 2:SUITE 501
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7527
Practice Address - Country:US
Practice Address - Phone:410-337-6800
Practice Address - Fax:410-337-8686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD248682084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8500Medicare PIN