Provider Demographics
NPI:1780853804
Name:VANDEMARK, JENNIFER MARY (DPM)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARY
Last Name:VANDEMARK
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:610-387-4520
Mailing Address - Fax:610-387-4526
Practice Address - Street 1:100 MARIS GROVE WAY
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1282
Practice Address - Country:US
Practice Address - Phone:610-387-4520
Practice Address - Fax:610-387-4526
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASC005881213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
3705064000OtherKEYSTONE/PERSONAL CHOICE BCBS
VA2091879OtherHIGHMARK BCBS
27-11888OtherEVERCARE
611455212001OtherTRICARE
VA2091879OtherHIGHMARK BCBS
138470R3WMedicare PIN