Healthcare Provider Details

I. General information

NPI: 1548235716
Provider Name (Legal Business Name): JENNIFER S AMMONS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 PETERS ROAD SUITE 202
LITITZ PA
17543-7685
US

IV. Provider business mailing address

1570 FRUITVILLE PIKE ROSEVILLE PEDIATRICS
LANCASTER PA
17601-4087
US

V. Phone/Fax

Practice location:
  • Phone: 717-569-6481
  • Fax:
Mailing address:
  • Phone: 717-569-6481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD073304L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier81127 S1BX
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGEISINGER HEALTH PLAN
# 2
Identifier964196
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE SHIELD
# 3
Identifier7941403
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA NON-HMO
# 4
IdentifierP002592
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGATEWAY HEALTH PLAN
# 5
Identifier0018412620004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 6
Identifier3568634
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA HMO
# 7
Identifier20027799
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAMERIHEALTH MERCY HEALTH
# 8
IdentifierP002592
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHEALTH ASSURANCE
# 9
Identifier50015642
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCAPITAL BLUE CROSS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: