Provider Demographics
NPI:1669266698
Name:ASIMOLE, JEPHTHAH
Entity type:Individual
Prefix:
First Name:JEPHTHAH
Middle Name:
Last Name:ASIMOLE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 TREEWAY CT APT 2C
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3489
Mailing Address - Country:US
Mailing Address - Phone:443-431-0618
Mailing Address - Fax:
Practice Address - Street 1:100 WEST RD STE 300
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2370
Practice Address - Country:US
Practice Address - Phone:443-431-0618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMT0147808374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician