Provider Demographics
NPI:1962490243
Name:JENNINGS, ANTHONY S (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:S
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3049
Mailing Address - Country:US
Mailing Address - Phone:856-428-6768
Mailing Address - Fax:856-429-1926
Practice Address - Street 1:27 COVERED BRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2945
Practice Address - Country:US
Practice Address - Phone:856-428-6768
Practice Address - Fax:856-429-1926
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03158700207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5454000Medicaid
NJ162952Medicare PIN
NJ5454000Medicaid
PA049603Medicare PIN