Provider Demographics
NPI:1851317754
Name:SHORT, JEFFREY EDWARD (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:EDWARD
Last Name:SHORT
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 STREAM VALLEY OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1175
Mailing Address - Country:US
Mailing Address - Phone:410-305-0232
Mailing Address - Fax:410-305-0232
Practice Address - Street 1:KIMBROUGH AMBULATORY CARE CENTER
Practice Address - Street 2:LLEWELLYN RD
Practice Address - City:FT MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755
Practice Address - Country:US
Practice Address - Phone:301-677-5069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4996208D00000X, 207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF52902Medicare UPIN