Provider Demographics
NPI:1538179130
Name:JOBES, ETTALY FRANKE (MD)
Entity type:Individual
Prefix:MRS
First Name:ETTALY
Middle Name:FRANKE
Last Name:JOBES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ETTALY
Other - Middle Name:KARA
Other - Last Name:FRANKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:605 GLOBAL WAY
Mailing Address - Street 2:SUITE 119 ARUNDEL PEDIATRICS P. A.
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090
Mailing Address - Country:US
Mailing Address - Phone:410-789-7337
Mailing Address - Fax:410-789-0425
Practice Address - Street 1:605 GLOBAL WAY
Practice Address - Street 2:SUITE 119 ARUNDEL PEDIATRICS P.A.
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090
Practice Address - Country:US
Practice Address - Phone:410-789-7337
Practice Address - Fax:410-789-0425
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058930208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400024200Medicaid
MD155NL471Medicare PIN
MD400024200Medicaid