Provider Demographics
NPI:1538105838
Name:SIMMONS, JULIAN T (MD)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:T
Last Name:SIMMONS
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 1:7253 AMBASSADOR RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2710
Mailing Address - Country:US
Mailing Address - Phone:443-436-1116
Mailing Address - Fax:443-436-1256
Practice Address - Street 1:7253 AMBASSADOR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2710
Practice Address - Country:US
Practice Address - Phone:443-436-1116
Practice Address - Fax:443-436-1256
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00274062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD478601700Medicaid
D77917Medicare UPIN
MD300103555Medicare PIN
MD301L937YMedicare PIN
MD478601700Medicaid
MD300076164Medicare PIN
MD731LI078Medicare UPIN
P00396352Medicare PIN