Provider Demographics
NPI:1326023326
Name:JENSEN, ALLAN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:DAVID
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 EAST 33RD ST
Mailing Address - Street 2:SUITE 426
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3381
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 EAST 33RD ST
Practice Address - Street 2:SUITE 426
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3381
Practice Address - Country:US
Practice Address - Phone:410-235-1133
Practice Address - Fax:410-235-1267
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD8901207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD006271500Medicaid
MD4573ADMedicare ID - Type Unspecified
MD006271500Medicaid