Provider Demographics
NPI:1912902545
Name:MULLENDORE, JENNIFER E (DPM)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:E
Last Name:MULLENDORE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 THOMAS JOHNSON DRIVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4557
Mailing Address - Country:US
Mailing Address - Phone:301-695-9669
Mailing Address - Fax:301-695-0346
Practice Address - Street 1:182 THOMAS JOHNSON DR STE 204
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4557
Practice Address - Country:US
Practice Address - Phone:301-695-9669
Practice Address - Fax:301-695-0346
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01423213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery