Provider Demographics
NPI:1134121312
Name:JENSEN, CHRISTIAN EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:EDWARD
Last Name:JENSEN
Suffix:
Gender:M
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 690
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-0690
Mailing Address - Country:US
Mailing Address - Phone:410-479-2605
Mailing Address - Fax:410-479-3354
Practice Address - Street 1:9309 CORKELL RD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629
Practice Address - Country:US
Practice Address - Phone:410-479-2605
Practice Address - Fax:410-479-3354
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD14664207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine