Provider Demographics
NPI:1285663542
Name:SIMMONS-O'BRIEN, EVA F (MD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:F
Last Name:SIMMONS-O'BRIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8320 BELLONA AVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2022
Mailing Address - Country:US
Mailing Address - Phone:410-821-7645
Mailing Address - Fax:410-821-7576
Practice Address - Street 1:8320 BELLONA AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2022
Practice Address - Country:US
Practice Address - Phone:410-821-7645
Practice Address - Fax:410-821-7576
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD43953207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKEY7OtherBLUE SHIELD OF MD
MDKEY7OtherBLUE SHIELD OF MD
MDC49709Medicare UPIN
MD631MMedicare ID - Type Unspecified