Provider Demographics
NPI:1619395290
Name:SON, JENNIFER DANIELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:DANIELLA
Last Name:SON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:18101 PRINCE PHILIP DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18101 PRINCE PHILIP DR
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1514
Practice Address - Country:US
Practice Address - Phone:301-260-3292
Practice Address - Fax:301-260-3293
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125064690208600000X
MDD00903462086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery