Provider Demographics
NPI:1154457455
Name:PACKARD, JENNIFER PELLI (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:PELLI
Last Name:PACKARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:188 ROUTE 101
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-5420
Mailing Address - Country:US
Mailing Address - Phone:603-663-8052
Mailing Address - Fax:603-663-8056
Practice Address - Street 1:188 ROUTE 101
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-5420
Practice Address - Country:US
Practice Address - Phone:603-663-8052
Practice Address - Fax:603-663-8056
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14972208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics