Provider Demographics
NPI:1619014263
Name:TVERSKY, JODY ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:ROBERT
Last Name:TVERSKY
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:PO BOX 64264
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4264
Mailing Address - Country:US
Mailing Address - Phone:410-550-2300
Mailing Address - Fax:
Practice Address - Street 1:5501 HOPKINS BAYVIEW CIR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-6821
Practice Address - Country:US
Practice Address - Phone:410-550-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5458207KA0200X
CT042352207R00000X
HIMD-13065207R00000X
NY250668207RA0201X
MDD66119207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMD-13065OtherHAWAII MEDICAL LICENSE
CT042352OtherCT STATE LICENSE
MDD0066119OtherMARYLAND STATE MEDICAL LICENSE
MDD0066119OtherMARYLAND STATE MEDICAL LICENSE
CT042352OtherCT STATE LICENSE
MD255606ZBR2Medicare PIN