Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | D0058574 | MD |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | D0058574 | MD |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | D0058574 | MD |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | D0058574 | MD |
NPI | 1851339550 |
---|---|
Provider Name | Clifford L Jeng |
First Address | Baltimore, MD 21202-2102 |
Second Address | Baltimore, MD 21202-2102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 06/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
432152900 | (05) | MD |
F730 / 0002 | BLUECHOICE (01) | MD |
G73529 | (02) | |
KBM7 / 615260-01 | BC / BS OF MD (01) | MD |