Basic Information
| Provider Information | |||||||||
| NPI: | 1588000152 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENNINGS | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 BRADDOCK AVE | ||||||||
| Address2: | |||||||||
| City: | BRADDOCK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151041856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126365044 | ||||||||
| FaxNumber: | 4122712361 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 BRADDOCK AVE | ||||||||
| Address2: | |||||||||
| City: | BRADDOCK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126365044 | ||||||||
| FaxNumber: | 4122712361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2013 | ||||||||
| LastUpdateDate: | 10/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD458372 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 103132383 | 05 | PA | MEDICAID |