1336248756 NPI number — DR. JOHN T JENNINGS DC

Table of content: DR. JOHN T JENNINGS DC (NPI 1336248756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336248756 NPI number — DR. JOHN T JENNINGS DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENNINGS
Provider First Name:
JOHN
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336248756
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
711 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEVENSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-643-7100
Provider Business Mailing Address Fax Number:
410-643-9493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEVENSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-643-7100
Provider Business Practice Location Address Fax Number:
410-643-9493
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  01284 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0586388 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 350035280 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 42514402 . This is a "CAREFIRST OF MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T447-0001 . This is a "BLUE CROSS OF DC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 200321 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 219508 . This is a "ALLIANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 200321 . This is a "ACN GROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: M380 . This is a "BLUE CROSS OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 219508 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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