Provider Demographics
NPI:1942298245
Name:PREISS, JENNIFER ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELLEN
Last Name:PREISS
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 1:651 HOLIDAY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-2740
Mailing Address - Country:US
Mailing Address - Phone:412-922-8490
Mailing Address - Fax:412-921-1194
Practice Address - Street 1:651 HOLIDAY DR STE 100
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-2740
Practice Address - Country:US
Practice Address - Phone:412-922-8490
Practice Address - Fax:412-921-1194
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045204L207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001254517Medicaid
PA0012545170001Medicaid
PAE39642Medicare UPIN