Provider Demographics
NPI:1841230455
Name:DUKOWICZ, JENNIFER D (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:D
Last Name:DUKOWICZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:DALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 602373
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2373
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:310 LONG SHOALS RD
Practice Address - Street 2:SUITE 310
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-8794
Practice Address - Country:US
Practice Address - Phone:828-213-8235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12373207R00000X
NC2007-01304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE7795OtherMEDICARE #
VT1010760Medicaid
NHI00444Medicare UPIN
NHRE7795OtherMEDICARE #