Healthcare Provider Details

I. General information

NPI: 1831395714
Provider Name (Legal Business Name): JENNIFER HAYLEY HEPPS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JENNIFER HEPPS

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-0004
US

IV. Provider business mailing address

5204 CARSON CT
ELLICOTT CITY MD
21043-8015
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-6168
  • Fax:
Mailing address:
  • Phone: 215-760-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0068486
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: