Provider Demographics
NPI:1053383117
Name:GINSBERG, JACALYN GORDON (DO)
Entity type:Individual
Prefix:MRS
First Name:JACALYN
Middle Name:GORDON
Last Name:GINSBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 RITCHIE HWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21176
Mailing Address - Country:US
Mailing Address - Phone:410-647-8306
Mailing Address - Fax:410-315-8444
Practice Address - Street 1:844 RITCHIE HWY
Practice Address - Street 2:SUITE 206
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21176
Practice Address - Country:US
Practice Address - Phone:410-647-8306
Practice Address - Fax:410-315-8444
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH51249208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11120OtherBS POS
OH64OtherBS
T5930002OtherBLUE CHOICE
H51249OtherMD LICENSE #
08795OtherPHN
T5930002OtherBSFED
T5930002OtherBSFED
G65954Medicare UPIN