Provider Demographics
NPI:1437450822
Name:CECIL, JENNIFER S (PA-C, MS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:CECIL
Suffix:
Gender:F
Credentials:PA-C, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ALEXANDER CHASE APT B
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9010
Mailing Address - Country:US
Mailing Address - Phone:443-212-5596
Mailing Address - Fax:
Practice Address - Street 1:216 WASHINGTON HEIGHTS MED CTR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5665
Practice Address - Country:US
Practice Address - Phone:410-848-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004321363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1095524OtherNCCPA CERTIFICATION