Provider Demographics
NPI:1538119854
Name:BAUBLITZ BRENENBORG, JENNIE CORINNE REBECCA (DO)
Entity Type:Individual
Prefix:MRS
First Name:JENNIE CORINNE
Middle Name:REBECCA
Last Name:BAUBLITZ BRENENBORG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JENNNIE CORINNE
Other - Middle Name:REBECCA
Other - Last Name:BAUBLITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2150 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-358-0800
Mailing Address - Fax:717-358-0803
Practice Address - Street 1:2150 HARRISBURG PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-358-0800
Practice Address - Fax:717-358-0803
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012356208VP0000X
PAOS-012356-L2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
099873E3ZMedicare ID - Type Unspecified
I51183Medicare UPIN