Provider Demographics
NPI:1104087584
Name:BEPPLE, JENNIFER L (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BEPPLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:25 CROSSROADS DRVIE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117
Mailing Address - Country:US
Mailing Address - Phone:443-738-2872
Mailing Address - Fax:
Practice Address - Street 1:10710 CHARTER DR.
Practice Address - Street 2:SUITE 130
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3128
Practice Address - Country:US
Practice Address - Phone:410-772-7000
Practice Address - Fax:410-772-7089
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0069291208800000X
MD1026692208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD078400100Medicaid
MD168429ZE23Medicare PIN