Provider Demographics
NPI:1760476105
Name:SYME, JACKIE (MD)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:SYME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 64023
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4023
Mailing Address - Country:US
Mailing Address - Phone:410-280-6577
Mailing Address - Fax:410-280-6515
Practice Address - Street 1:2401 BRANDERMILL BLVD
Practice Address - Street 2:SITE 301
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1690
Practice Address - Country:US
Practice Address - Phone:410-451-9064
Practice Address - Fax:410-451-9065
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00444762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD302M409FMedicare PIN
MDF20431Medicare UPIN