Healthcare Provider Details

I. General information

NPI: 1437190154
Provider Name (Legal Business Name): JEANNINE MOGAVERO THEORET M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANNINE MOGAVERO MD

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 DEFENSE HWY STE 403
ANNAPOLIS MD
21401-7020
US

IV. Provider business mailing address

424 SEVERNSIDE DR
SEVERNA PARK MD
21146-2200
US

V. Phone/Fax

Practice location:
  • Phone: 410-844-8998
  • Fax:
Mailing address:
  • Phone: 617-901-1316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0062774
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberD0062774
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: