Provider Demographics
NPI:1508862772
Name:SUMMER, JENNIFER G (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:G
Last Name:SUMMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4529 JESSUP GROVE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9407
Mailing Address - Country:US
Mailing Address - Phone:336-605-0190
Mailing Address - Fax:336-605-0930
Practice Address - Street 1:4529 JESSUP GROVE RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9407
Practice Address - Country:US
Practice Address - Phone:336-605-0190
Practice Address - Fax:336-605-0930
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2000-01439208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics