Provider Demographics
NPI:1710900931
Name:PLASSE, JEROME STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:STEVEN
Last Name:PLASSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:10085 RED RUN BLVD
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-0668
Mailing Address - Country:US
Mailing Address - Phone:410-363-3767
Mailing Address - Fax:410-363-0911
Practice Address - Street 1:10085 RED RUN BLVD
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117
Practice Address - Country:US
Practice Address - Phone:410-363-3767
Practice Address - Fax:410-363-0911
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0009576208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C57476Medicare UPIN
6759Medicare ID - Type Unspecified