Provider Demographics
NPI:1497918791
Name:PRABHU, JENNIFER SCHWALBE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SCHWALBE
Last Name:PRABHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:PAULINE
Other - Last Name:SCHWALBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2850 N RIDGE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3396
Mailing Address - Country:US
Mailing Address - Phone:410-465-8119
Mailing Address - Fax:
Practice Address - Street 1:2850 N RIDGE RD STE 103
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3396
Practice Address - Country:US
Practice Address - Phone:410-465-8119
Practice Address - Fax:410-203-2016
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0074836208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics