Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | A0000846 | MD |
Y | 213ES0000X | Sports Medicine | A0000846 | MD |
NPI | 1174077176 |
---|---|
Provider Name | Jessica Simeone |
First Address | Cockeysville, MD 21030-3065 |
Second Address | Laurel, MD 20707-4877 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2016 |
Last Update Date | 08/08/2016 |