Provider Demographics
NPI:1881149847
Name:SCHAEFFER, JENNIFER LEIGH (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEIGH
Last Name:SCHAEFFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 BLACKWELL RD
Mailing Address - Street 2:STE 275
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3472
Mailing Address - Country:US
Mailing Address - Phone:301-545-5512
Mailing Address - Fax:301-979-9090
Practice Address - Street 1:9601 BLACKWELL RD
Practice Address - Street 2:STE 275
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3472
Practice Address - Country:US
Practice Address - Phone:301-545-5512
Practice Address - Fax:301-979-9090
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC06187363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC531878ZN0ZMedicare PIN