Provider Demographics
NPI:1992803415
Name:DENNIS, JOSEPHINE ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:ELIZABETH
Last Name:DENNIS
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:PO BOX 1237
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-0237
Mailing Address - Country:US
Mailing Address - Phone:410-997-5762
Mailing Address - Fax:410-715-9993
Practice Address - Street 1:10806 HICKORY RIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3622
Practice Address - Country:US
Practice Address - Phone:410-715-9990
Practice Address - Fax:410-715-9993
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD43967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD593431100Medicaid
MD593431100Medicaid
MDG15741Medicare UPIN