Provider Demographics
NPI:1144265877
Name:RIEDINGER, JENNIFER LEE (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:RIEDINGER
Suffix:
Gender:F
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:PO BOX
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8601 VETERANS HWY
Practice Address - Street 2:SUITE 204
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1547
Practice Address - Country:US
Practice Address - Phone:410-729-0424
Practice Address - Fax:410-729-0492
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050725207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD110184187 CC0691OtherRR MEDICARE
DCO242-0015OtherCARE FIRST BLUE CROSS
MD1392OtherBRAVO/ELDER HEALTH
MD69901OtherAMERIGROUP
MD213842OtherCIGNA
MD7239055OtherAETNA PPO
MD197300200Medicaid
MD3134395OtherAETNA HMO
MD768973-03OtherCARE FIRST BLUE CROSS
MD38226OtherJOHNS HOPKINS HEALTHCARE
MD3134395OtherAETNA HMO