MEDICARE: MRS. JENNIFER JING FANG M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LGM441	MD

General Provider Information

NPI Number	:	1215272687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER JING FANG M.S.

Provider Business Mailing Address
First Line	:	20 PLEASANT RIDGE DR
Second Line	:	SUITE A
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-2560
Country	:	US
Telephone Number	:	410-902-5940
Fax Number	:	410-902-5941

Provider Business Practice Location Address
First Line	:	20 PLEASANT RIDGE DR
Second Line	:	SUITE A
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-2560
Country	:	US
Telephone Number	:	410-902-5940
Fax Number	:	410-902-5941

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2012
Last Update Date	:	12/11/2012

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