Provider Demographics
NPI:1457348559
Name:HAHNE, JENNY RANAE (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:RANAE
Last Name:HAHNE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HOSPITAL DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5884
Mailing Address - Country:US
Mailing Address - Phone:410-766-3937
Mailing Address - Fax:410-761-4386
Practice Address - Street 1:200 HOSPITAL DR
Practice Address - Street 2:SUITE 600
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5884
Practice Address - Country:US
Practice Address - Phone:410-766-3937
Practice Address - Fax:410-761-4386
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1911152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDV06413Medicare UPIN
MD494LMedicare PIN