Provider Demographics
NPI:1750467254
Name:EBELING, JAMES GERARD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GERARD
Last Name:EBELING
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 1:1217 BOYCE AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-3604
Mailing Address - Country:US
Mailing Address - Phone:410-828-0161
Mailing Address - Fax:
Practice Address - Street 1:7401 OSLER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7673
Practice Address - Country:US
Practice Address - Phone:410-828-0235
Practice Address - Fax:410-821-8244
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD34827207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4067776OtherAETNA
DCT6690001OtherCAREFIRST OF NCA
MD1344595OtherCIGNA HEALTHCARE
MD2120632OtherALLIANCE/MAMSI
MD2959OtherCAREFIRST OF MARYLAND
MD2959Medicare PIN
MD4067776`OtherAETNA
MD1344595OtherCIGNA HEALTHCARE