Provider Demographics
NPI:1629240122
Name:JASPER, DONNA L (DO)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:L
Last Name:JASPER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 JENNIFER RD STE 240
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7995
Mailing Address - Country:US
Mailing Address - Phone:410-571-9000
Mailing Address - Fax:410-266-1507
Practice Address - Street 1:170 JENNIFER RD STE 240
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7995
Practice Address - Country:US
Practice Address - Phone:410-571-9000
Practice Address - Fax:410-266-1507
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0053769208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
1503639OtherAETNA HMO
145724700OtherUS DEPT OF LABOR
021324OtherJOHNS HOPKINS HEALTHCARE
MD170006500Medicaid
5213700OtherAETNA PPO
0004OtherCAREFIRST
10243748OtherAMERIGROUP/AMERICAID
61485606OtherCAREFIRST
61485606OtherCAREFIRST
MD170006500Medicaid
182430Y5ZMedicare PIN
118AMedicare PIN