Provider Demographics
NPI:1821119272
Name:CHEESEMAN, JENNIFER (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CHEESEMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:LYN CHEESEMAN
Other - Last Name:TROST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:41464 PENSIVE ST
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-5841
Mailing Address - Country:US
Mailing Address - Phone:240-298-7512
Mailing Address - Fax:
Practice Address - Street 1:15045 BURNT STORE RD
Practice Address - Street 2:
Practice Address - City:HUGHESVILLE
Practice Address - State:MD
Practice Address - Zip Code:20637-2699
Practice Address - Country:US
Practice Address - Phone:301-274-8168
Practice Address - Fax:833-449-3814
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003203363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant