Provider Demographics
NPI:1639256415
Name:GLATTFELDER, JENNIFER LYNN (CPNP)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LYNN
Last Name:GLATTFELDER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:GLATTFELDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPNP
Mailing Address - Street 1:8114 SANDPIPER CIRCLE
Mailing Address - Street 2:#100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236
Mailing Address - Country:US
Mailing Address - Phone:410-933-8101
Mailing Address - Fax:410-933-8106
Practice Address - Street 1:8114 SANDPIPER CIRCLE
Practice Address - Street 2:#100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236
Practice Address - Country:US
Practice Address - Phone:410-933-8101
Practice Address - Fax:410-933-8106
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR143206208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4089979Medicaid