Provider Demographics
NPI:1447293964
Name:JEFFRIES, RUDOLPH JR (MD)
Entity type:Individual
Prefix:
First Name:RUDOLPH
Middle Name:
Last Name:JEFFRIES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 AMHERST AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4665
Mailing Address - Country:US
Mailing Address - Phone:301-933-7827
Mailing Address - Fax:240-290-0342
Practice Address - Street 1:301 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5803
Practice Address - Country:US
Practice Address - Phone:410-787-4565
Practice Address - Fax:410-766-7602
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD39590207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD075031000Medicaid
MDK727641LMedicare PIN
MD075031000Medicaid