Provider Demographics
NPI:1134216708
Name:AVENTURO, JENIFER ANN (MD)
Entity type:Individual
Prefix:DR
First Name:JENIFER
Middle Name:ANN
Last Name:AVENTURO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENIFER
Other - Middle Name:
Other - Last Name:LUCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:15235 SHADY GROVE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6273
Mailing Address - Country:US
Mailing Address - Phone:301-330-1366
Mailing Address - Fax:
Practice Address - Street 1:15235 SHADY GROVE RD STE 101
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6273
Practice Address - Country:US
Practice Address - Phone:301-330-1366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052268207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4404310Medicaid