Provider Demographics
NPI:1730299678
Name:PARKERSON, JOHN BEVERIDGE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BEVERIDGE
Last Name:PARKERSON
Suffix:JR
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 1:4717 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4908
Mailing Address - Country:US
Mailing Address - Phone:410-366-3627
Mailing Address - Fax:410-366-1183
Practice Address - Street 1:4717 FALLS RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4908
Practice Address - Country:US
Practice Address - Phone:410-366-3627
Practice Address - Fax:410-366-1183
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD328752083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC1-0005889OtherSTATE PHYSICIAN LICENSE
MDD32875OtherSTATE PHYSIAN LICENSE
MDD32875OtherSTATE PHYSIAN LICENSE
MDD73806Medicare UPIN