Provider Demographics
NPI:1942655253
Name:HIDINGER, JENNIFER WATSON (MD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:WATSON
Last Name:HIDINGER
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 1:1321 OBERLIN RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-2052
Mailing Address - Country:US
Mailing Address - Phone:198-284-7479
Mailing Address - Fax:
Practice Address - Street 1:1321 OBERLIN RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-2052
Practice Address - Country:US
Practice Address - Phone:198-284-7479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-01626208000000X
TN58427208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1942655253Medicaid