Provider Demographics
NPI:1275741431
Name:SEIBEL, JENNIFER MICHELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:SEIBEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2014 S TOLLGATE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-5903
Mailing Address - Country:US
Mailing Address - Phone:410-569-9533
Mailing Address - Fax:410-569-1254
Practice Address - Street 1:2014 S TOLLGATE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-5903
Practice Address - Country:US
Practice Address - Phone:410-569-9533
Practice Address - Fax:410-569-1254
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003393363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD086984861Medicaid