Provider Demographics
NPI:1558552174
Name:JONES, RICHARD LEROY JR (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEROY
Last Name:JONES
Suffix:JR
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 1:3501 SINCLAIR LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-2029
Mailing Address - Country:US
Mailing Address - Phone:410-732-8800
Mailing Address - Fax:410-534-2392
Practice Address - Street 1:900 CATON AVE
Practice Address - Street 2:MAILBOX 081
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5201
Practice Address - Country:US
Practice Address - Phone:443-703-3200
Practice Address - Fax:443-703-3201
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD78115207V00000X
IL036126558207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036126558Medicaid
ILIL4393001Medicare UPIN