Provider Demographics
NPI:1275733396
Name:BUCHANAN, JENNIFER SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SUE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:BUCHANAN
Other - Last Name:DIAZ-ARRASTIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2401 BLUERIDGE AVE
Mailing Address - Street 2:#210
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4517
Mailing Address - Country:US
Mailing Address - Phone:301-933-6440
Mailing Address - Fax:301-933-5923
Practice Address - Street 1:2401 BLUERIDGE AVE
Practice Address - Street 2:#210
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-4517
Practice Address - Country:US
Practice Address - Phone:301-933-6440
Practice Address - Fax:301-933-5923
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4875208000000X
PAMD457529208000000X
MDD007446208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF63748Medicare UPIN