Provider Demographics
NPI:1770586810
Name:CITRON, JASON RYAN (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:RYAN
Last Name:CITRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9105 FRANKLIN SQUARE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-5333
Mailing Address - Country:US
Mailing Address - Phone:410-682-6800
Mailing Address - Fax:410-682-2783
Practice Address - Street 1:9105 FRANKLIN SQUARE DR
Practice Address - Street 2:STE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-5333
Practice Address - Country:US
Practice Address - Phone:410-682-6800
Practice Address - Fax:410-682-2783
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO62760174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS858L505Medicare PIN