Provider Demographics
NPI:1659562841
Name:TROMBERG, JENNIFER SARA (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SARA
Last Name:TROMBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 826696
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-6696
Mailing Address - Country:US
Mailing Address - Phone:434-979-7700
Mailing Address - Fax:434-979-7715
Practice Address - Street 1:902 E JEFFERSON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5397
Practice Address - Country:US
Practice Address - Phone:434-979-7700
Practice Address - Fax:434-979-7715
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC185159207ND0101X
ARE-6984207ND0101X
VA0101255093207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVC793AMedicare PIN