Provider Demographics
NPI:1407076128
Name:KUCINE, JEFFREY MARLOWE (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARLOWE
Last Name:KUCINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 RIDGELY AVE
Mailing Address - Street 2:SUITE 14C
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1417
Mailing Address - Country:US
Mailing Address - Phone:410-263-3313
Mailing Address - Fax:410-263-4651
Practice Address - Street 1:107 RIDGELY AVE
Practice Address - Street 2:SUITE 14C
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1417
Practice Address - Country:US
Practice Address - Phone:410-263-3313
Practice Address - Fax:410-263-4651
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0036889207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E15222Medicare UPIN