Healthcare Provider Details

I. General information

NPI: 1922203009
Provider Name (Legal Business Name): JENNIFER L. DREILING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 BATTERSON PARK RD STE 106
FARMINGTON CT
06032-2571
US

IV. Provider business mailing address

76 BATTERSON PARK RD STE 106
FARMINGTON CT
06032-2571
US

V. Phone/Fax

Practice location:
  • Phone: 703-635-8976
  • Fax: 203-879-0834
Mailing address:
  • Phone: 703-635-8976
  • Fax: 203-879-0834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number69517
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD044070
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number69517
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: