Provider Demographics
NPI:1104043561
Name:HENNESSY, JEANNIE (MD)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:
Last Name:HENNESSY
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 1:2100 MARBLE CLIFF OFFICE PARK
Mailing Address - Street 2:H088
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1056
Mailing Address - Country:US
Mailing Address - Phone:614-299-7546
Mailing Address - Fax:614-588-8835
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:H088
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-1692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT187278207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology