Provider Demographics
NPI:1245467794
Name:HENSLEY, JENNIFER C (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:HENSLEY
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:ANDOVER PEDIATRICS NPI 1548393176
Mailing Address - Street 2:203 TURNPIKE ST, SUITE 200
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845
Mailing Address - Country:US
Mailing Address - Phone:978-475-4522
Mailing Address - Fax:978-688-6047
Practice Address - Street 1:ANDOVER PEDIATRICS NPI 1548393176
Practice Address - Street 2:203 TURNPIKE ST, SUITE 200
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845
Practice Address - Country:US
Practice Address - Phone:978-475-4522
Practice Address - Fax:978-688-6047
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-240526208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA250183OtherMASS STATE LICENSE
MA110093450AMedicaid
MA1245467794OtherNPI