Healthcare Provider Details

I. General information

NPI: 1023967668
Provider Name (Legal Business Name): JENNIFER ALLEN ME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 RUSSELL AVE STE 202
GAITHERSBURG MD
20879-6226
US

IV. Provider business mailing address

PO BOX 4137
ROCKVILLE MD
20849-4137
US

V. Phone/Fax

Practice location:
  • Phone: 240-205-2325
  • Fax:
Mailing address:
  • Phone: 240-205-2325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1264003604
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: