Provider Demographics
NPI:1104962588
Name:LEE-SUMMERS, JENNIFER KIM (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KIM
Last Name:LEE-SUMMERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KIM
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:14207 SUMMIT LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3204
Mailing Address - Country:US
Mailing Address - Phone:410-979-5933
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-2101
Practice Address - Country:US
Practice Address - Phone:410-979-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT1011207L00000X
MDD62898207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD027999400Medicaid
MD027999400Medicaid
MD170806YUXMedicare PIN