Provider Demographics
NPI:1083763726
Name:FEARS, JONATHAN KIM (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:KIM
Last Name:FEARS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:985 PRINCE FREDERICK BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3492
Mailing Address - Country:US
Mailing Address - Phone:410-535-2005
Mailing Address - Fax:410-535-4850
Practice Address - Street 1:985 PRINCE FREDERICK BLVD STE 201
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3492
Practice Address - Country:US
Practice Address - Phone:410-535-2005
Practice Address - Fax:410-535-4850
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD39522207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD42589101OtherCAREFIRST OF MARYLAND
MD437339OtherMAMSI HMO SPECIALIST
MD110032510OtherRAILROAD MEDICARE
MD2148224OtherAETNA HMO PCP
MD7720001OtherAETNA PPO SPECIALIST
MD837339OtherMAMSI HMO PCP
MD2154481OtherAETNA HMO SPECIALIST
MDC0410003OtherCAREFIRST OF DC
MD558681000Medicaid
MD4461101OtherAETNA NON-HMO PCP
MD110032510OtherRAILROAD MEDICARE
MD022L373AMedicare ID - Type UnspecifiedMEDICARE PROVIDER #