Provider Demographics
NPI:1144769530
Name:MICHAEL R. SIMMONS, MD
Entity Type:Organization
Organization Name:MICHAEL R. SIMMONS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-252-6400
Mailing Address - Street 1:57 W TIMONIUM RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:57 W TIMONIUM RD
Practice Address - Street 2:SUITE 208
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3125
Practice Address - Country:US
Practice Address - Phone:410-252-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0030190261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty