Provider Demographics
NPI:1982636601
Name:LANDSMAN, JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:LANDSMAN
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 1:5525 RESEARCH PARK DR FL 4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4873
Mailing Address - Country:US
Mailing Address - Phone:781-534-7100
Mailing Address - Fax:781-534-7358
Practice Address - Street 1:8800 WALTHER BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-9001
Practice Address - Country:US
Practice Address - Phone:781-534-7100
Practice Address - Fax:781-534-7358
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053115207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
093NER-614408-04OtherCAREFIRST BCBS OF MD
KG01SE-61440804OtherBCBS
T016-0022OtherCAREFIRST BCBS OF DC (CCI)
0943ER-614408-05OtherCAREFIRST BCBS OF MD
KG01ER-61440804OtherCAREFIRST BCBS OF MD (CCI)
MDP14924OtherBCBS OF MD
MD008203101Medicaid
093NSE-614408-04OtherCAREFIRST BCBS OF MD
DC0022OtherBCBS
9676-0019OtherCAREFIRST BCBS OF DC
0403088OtherEVERCARE
MD211110100Medicaid
MD380001586Medicare PIN
MD590LA064Medicare PIN