Provider Demographics
NPI:1639332554
Name:PENA, JENNIFER M (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:PENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3300 GALLOWS RD FL SSB
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3307
Mailing Address - Country:US
Mailing Address - Phone:703-776-4005
Mailing Address - Fax:703-776-7068
Practice Address - Street 1:3300 GALLOWS RD FL SSB
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-373-3718
Practice Address - Fax:703-822-2190
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2020005391207R00000X
PAMD469838207R00000X
DCMD048614207R00000X
NY301130207R00000X
CODR.0063636207R00000X
VA0101247664207R00000X
CAC161524207R00000X
TN59075207R00000X
FLME139541207R00000X
TXS2146207R00000X
GA85158207R00000X
KS04-43047207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine