Provider Demographics
NPI:1528072915
Name:MOYNIHAN, JENNIFER KIM (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KIM
Last Name:MOYNIHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9501 OLD ANNAPOLIS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6335
Mailing Address - Country:US
Mailing Address - Phone:410-992-9339
Mailing Address - Fax:410-964-5150
Practice Address - Street 1:9501 OLD ANNAPOLIS RD STE 101
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-6335
Practice Address - Country:US
Practice Address - Phone:410-992-9339
Practice Address - Fax:410-964-5150
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD71715208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics