Healthcare Provider Details

I. General information

NPI: 1700230539
Provider Name (Legal Business Name): JENNIFER FARRELL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LOOMIS D.O.

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10260 SILVERSIDE ST STE 100
IJAMSVILLE MD
21754-9174
US

IV. Provider business mailing address

10260 SILVERSIDE ST STE 100
IJAMSVILLE MD
21754-9174
US

V. Phone/Fax

Practice location:
  • Phone: 301-682-4100
  • Fax: 301-682-9100
Mailing address:
  • Phone: 301-682-4100
  • Fax: 301-682-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0096681
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: