Provider Demographics
NPI:1740312149
Name:HIRATA, JEFFREY T (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:T
Last Name:HIRATA
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 1:2002 MEDICAL PKWY
Mailing Address - Street 2:SUITE 235
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3046
Mailing Address - Country:US
Mailing Address - Phone:410-266-2770
Mailing Address - Fax:410-841-6251
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 235
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-266-2770
Practice Address - Fax:410-841-6251
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1029412085R0202X
MDD00648022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS645OtherMEDICARE AAD
MD1863725OtherAAD AMERIGROUP
MD1073OtherBCBS AAD
MDG0178OtherMEDICARE AAD
MEK606ANOtherAAD BOWIE
ME154158ZDYCOtherARA MEDICARE GROUP PTAN
MD764801400OtherMEDICAID AAD
MD417295700OtherAAD MEDICAL ASSISTANCE
MD1069OtherBCBS ARA