Provider Demographics
NPI:1861898983
Name:O'HARA, JENNUM CHRISTINE (MAC, LAC)
Entity type:Individual
Prefix:
First Name:JENNUM
Middle Name:CHRISTINE
Last Name:O'HARA
Suffix:
Gender:F
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 S CHESTER ST
Mailing Address - Street 2:APT 1
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-2007
Mailing Address - Country:US
Mailing Address - Phone:518-669-2982
Mailing Address - Fax:
Practice Address - Street 1:5570 STERRETT PL
Practice Address - Street 2:SUITE 210
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2641
Practice Address - Country:US
Practice Address - Phone:518-669-2982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02156171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist