Provider Demographics
NPI:1568501070
Name:MAUPIN, JEFFREY EADES (P T)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:EADES
Last Name:MAUPIN
Suffix:
Gender:M
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 NE ISLES DR
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-3107
Mailing Address - Country:US
Mailing Address - Phone:443-674-8155
Mailing Address - Fax:
Practice Address - Street 1:18 MONTGOMERY DR
Practice Address - Street 2:STE 10
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-3817
Practice Address - Country:US
Practice Address - Phone:410-287-5057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22136225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist