Provider Demographics
NPI:1427373687
Name:LENNON, CHAD JASON (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:JASON
Last Name:LENNON
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 1:9771 TIGER LILY PATH
Mailing Address - Street 2:APT. 3B
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723
Mailing Address - Country:US
Mailing Address - Phone:917-669-6237
Mailing Address - Fax:
Practice Address - Street 1:9771 TIGER LILY PATH
Practice Address - Street 2:APT. 3B
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723
Practice Address - Country:US
Practice Address - Phone:917-669-6237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD745122084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program