Provider Demographics
NPI:1013982529
Name:KING, JEREMY ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:ALAN
Last Name:KING
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 1:4 ENGLISH RUN TURN
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-8842
Mailing Address - Country:US
Mailing Address - Phone:410-472-0897
Mailing Address - Fax:
Practice Address - Street 1:2330 W JOPPA RD
Practice Address - Street 2:SUITE 301
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4609
Practice Address - Country:US
Practice Address - Phone:410-583-2754
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76036207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology