Healthcare Provider Details

I. General information

NPI: 1992753610
Provider Name (Legal Business Name): JENNIFER CLANCY LIVINGOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER C LIVINGOOD M.D.

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 GRANBY ST
NORFOLK VA
23517-2349
US

IV. Provider business mailing address

1909 GRANBY ST
NORFOLK VA
23517-2349
US

V. Phone/Fax

Practice location:
  • Phone: 757-640-0022
  • Fax: 757-627-8064
Mailing address:
  • Phone: 757-640-0022
  • Fax: 757-627-8064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101232704
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: