Provider Demographics
NPI:1013104884
Name:HOWARD, JEROME (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:
Last Name:HOWARD
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 1:6111 RUMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3125
Mailing Address - Country:US
Mailing Address - Phone:704-596-5067
Mailing Address - Fax:704-599-9458
Practice Address - Street 1:6111 RUMPLE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3125
Practice Address - Country:US
Practice Address - Phone:704-596-5067
Practice Address - Fax:704-599-9458
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC18523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC207400BMedicare PIN
NCC84598Medicare UPIN