Provider Demographics
NPI:1942203245
Name:JEROME, SCOTT D (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:JEROME
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-5793
Mailing Address - Fax:410-328-0248
Practice Address - Street 1:410 MALCOLM DR
Practice Address - Street 2:STE A
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6160
Practice Address - Country:US
Practice Address - Phone:410-876-0086
Practice Address - Fax:410-876-2946
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0039447207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD092691400Medicaid
MD521611-11OtherCAREFIRST - MD
MDS062-0326OtherCAREFIRST - REGIONAL
MD092691400Medicaid
MDP00630493Medicare PIN
MDE69608Medicare UPIN