Provider Demographics
NPI:1841256088
Name:LATING, JEFFREY M (PHD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:LATING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 N CALVERT ST
Mailing Address - Street 2:SUITE 670
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2867
Mailing Address - Country:US
Mailing Address - Phone:410-933-9000
Mailing Address - Fax:410-933-9085
Practice Address - Street 1:3333 N CALVERT ST
Practice Address - Street 2:SUITE 670
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2867
Practice Address - Country:US
Practice Address - Phone:410-933-9000
Practice Address - Fax:410-933-9085
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02963103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD729071300Medicaid
MDKL55Medicare ID - Type Unspecified