Provider Demographics
NPI:1225069636
Name:EATON, JENNIFER L (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:EATON
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:HEALTH RESOURCES AND SERVICES ADMINISTRATION
Mailing Address - Street 2:5600 FISHERS LANE
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20857-0001
Mailing Address - Country:US
Mailing Address - Phone:919-357-1891
Mailing Address - Fax:
Practice Address - Street 1:HEALTH RESOURCES AND SERVICES ADMINISTRATION
Practice Address - Street 2:5600 FISHERS LANE
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20857-0001
Practice Address - Country:US
Practice Address - Phone:919-357-1891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD66947207P00000X
NC207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD66947OtherMD MEDICAL LICENSE
NC5903900Medicaid
NC5903900Medicaid
I55283Medicare UPIN
MDD66947OtherMD MEDICAL LICENSE