Provider Demographics
NPI:1598835985
Name:DOERFER, DEBORAH J (CRNM)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:J
Last Name:DOERFER
Suffix:
Gender:F
Credentials:CRNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 WYMAN PARK DRIVE
Mailing Address - Street 2:SUITE 359A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211
Mailing Address - Country:US
Mailing Address - Phone:410-338-3016
Mailing Address - Fax:410-338-3690
Practice Address - Street 1:3100 WYMAN PARK DRIVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211
Practice Address - Country:US
Practice Address - Phone:410-338-3758
Practice Address - Fax:410-522-5136
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR079706367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD76426100Medicaid
R13071Medicare UPIN