Provider Demographics
NPI:1659782795
Name:JENNINGS, JESSE J (MD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:J
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:JAYE
Other - Last Name:GREENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3901 S ATHERTON ST STE 6
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-8324
Mailing Address - Country:US
Mailing Address - Phone:814-466-6396
Mailing Address - Fax:814-466-6056
Practice Address - Street 1:3901 S ATHERTON ST STE 6
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-8324
Practice Address - Country:US
Practice Address - Phone:814-466-6396
Practice Address - Fax:814-466-6056
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD466682207Y00000X
PAMT206188207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology