Provider Demographics
NPI:1881405652
Name:JEFFERSON, LAUREN P
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:P
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10250 BALTIMORE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-4202
Mailing Address - Country:US
Mailing Address - Phone:202-258-2385
Mailing Address - Fax:
Practice Address - Street 1:10250 BALTIMORE AVE STE 101
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-4202
Practice Address - Country:US
Practice Address - Phone:202-258-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1175531744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management