Provider Demographics
NPI:1841293040
Name:GILES, JENNIFER R (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:GILES
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 1:31519 WINTERPLACE PKWY
Mailing Address - Street 2:STE 1
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1884
Mailing Address - Country:US
Mailing Address - Phone:410-546-2500
Mailing Address - Fax:410-546-5005
Practice Address - Street 1:31519 WINTERPLACE PKWY
Practice Address - Street 2:STE 1
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1884
Practice Address - Country:US
Practice Address - Phone:410-546-2500
Practice Address - Fax:410-546-5005
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD427101700Medicaid
MD174L685YMedicare PIN
MD427101700Medicaid
MD410040851Medicare PIN