Provider Demographics
NPI:1669447991
Name:KIM JONES-FEARING M.D. LLC
Entity type:Organization
Organization Name:KIM JONES-FEARING M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES-FEARING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-421-9112
Mailing Address - Street 1:11221 KINSALE CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6131
Mailing Address - Country:US
Mailing Address - Phone:410-419-3769
Mailing Address - Fax:
Practice Address - Street 1:11221 KINSALE CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-6131
Practice Address - Country:US
Practice Address - Phone:410-419-3769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD461242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD655605OtherUNITED HEALTHCARE
MD413271800Medicaid
DC23320001OtherBC DC/METRO
MD65FCKBOtherBC MD
MD655605OtherUNITED HEALTHCARE
MD413271800Medicaid