Provider Demographics
NPI:1326093790
Name:SIMARD, J MARC (MD, PHD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:MARC
Last Name:SIMARD
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:MARC
Other - Middle Name:
Other - Last Name:SIMARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:PO BOX 64315
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4315
Mailing Address - Country:US
Mailing Address - Phone:410-328-8209
Mailing Address - Fax:410-328-1413
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:S12D
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-8209
Practice Address - Fax:410-328-1413
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD44232207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
460L297CMedicare PIN
MDE40953Medicare UPIN