Provider Demographics
NPI:1285657155
Name:SIMPLER, DANA (MD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:SIMPLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808-810 S CONKLING ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4303
Mailing Address - Country:US
Mailing Address - Phone:410-563-1700
Mailing Address - Fax:410-563-1702
Practice Address - Street 1:808-810 S CONKLING ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4303
Practice Address - Country:US
Practice Address - Phone:410-563-1700
Practice Address - Fax:410-563-1702
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035170207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD442111600Medicaid
7784Medicare ID - Type Unspecified
B69762Medicare UPIN