Provider Demographics
NPI:1427212414
Name:DURNAN, JERRY (OD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:DURNAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 REVOLUTION ST
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3748
Mailing Address - Country:US
Mailing Address - Phone:410-939-2200
Mailing Address - Fax:410-939-5980
Practice Address - Street 1:360 E PULASKI HWY STE 1B
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6592
Practice Address - Country:US
Practice Address - Phone:410-398-5240
Practice Address - Fax:410-398-4762
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD133369Medicare PIN
MD237LMedicare PIN