Provider Demographics
NPI:1780657627
Name:HURST, JANIS LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:JANIS
Middle Name:LEIGH
Last Name:HURST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10373A REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3617
Mailing Address - Country:US
Mailing Address - Phone:410-356-8186
Mailing Address - Fax:410-356-4180
Practice Address - Street 1:21 CROSSROADS DR
Practice Address - Street 2:STE 100
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5441
Practice Address - Country:US
Practice Address - Phone:410-356-8186
Practice Address - Fax:410-356-4180
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063224207U00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKA80OtherB/C B/S
MDJ062OtherB/C B/S
DC2849OtherB/C B/S
MD017354A00Medicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 99
MD434LL660Medicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 01
MDE19511Medicare UPIN
MDJ062OtherB/C B/S
MDCD4495Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MD435LL661Medicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 02
MDCD2566Medicare ID - Type UnspecifiedRAILROAD MEDICARE