Provider Demographics
NPI:1538116678
Name:JAMPEL, RISA (MD)
Entity type:Individual
Prefix:
First Name:RISA
Middle Name:
Last Name:JAMPEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CROSSROADS DR
Mailing Address - Street 2:SUITE 325
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5441
Mailing Address - Country:US
Mailing Address - Phone:410-356-0171
Mailing Address - Fax:410-356-0172
Practice Address - Street 1:21 CROSSROADS DR
Practice Address - Street 2:SUITE 325
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5441
Practice Address - Country:US
Practice Address - Phone:410-356-0171
Practice Address - Fax:410-356-0172
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD35193207N00000X
MD174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD444321700Medicaid
MD444321700Medicaid
H766M596Medicare PIN