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NPI Code Detail

MEDICARE: JENNIFER CANCINO MD

MEDICARE: JENNIFER CANCINO MD
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
1207Q00000XFamily Medicine PhysicianD0058038MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1W590-0003OTHERCAREFIRST BCBS GHMSI
2613037-01OTHERCAREFIRST BCBS MARYLAND
31989337OTHERUNITED
42600321OTHERAETNA PVN

General Provider Information

NPI Number : 1780676353
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER CANCINO MD
Provider Business Mailing Address
First Line : PO BOX 1110
Second Line :
City : UNION BRIDGE
State : MD
Zip : 21791-0579
Country : US
Telephone Number : 410-775-2622
Fax Number : 410-775-2050
Provider Business Practice Location Address
First Line : 7211 BANK CT
Second Line :
City : FREDERICK
State : MD
Zip : 21703-8483
Country : US
Telephone Number : 240-215-6370
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2005
Last Update Date : 04/30/2019

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