Provider Demographics
NPI:1538587704
Name:DORAN, JESSE
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:DORAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 WILKENS AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5222
Mailing Address - Country:US
Mailing Address - Phone:585-784-9861
Mailing Address - Fax:585-427-8424
Practice Address - Street 1:3407 WILKENS AVE
Practice Address - Street 2:STE 300
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5222
Practice Address - Country:US
Practice Address - Phone:410-644-5111
Practice Address - Fax:410-644-2715
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD91509207RC0200X, 207RC0000X
NY287413208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist