Provider Demographics
NPI:1447544242
Name:PAYNE, JENNIFER M (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:51 PETERS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-7685
Mailing Address - Country:US
Mailing Address - Phone:717-626-2167
Mailing Address - Fax:717-626-1915
Practice Address - Street 1:51 PETERS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7685
Practice Address - Country:US
Practice Address - Phone:717-626-2167
Practice Address - Fax:717-626-1915
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2020-05-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD450936207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102922223Medicaid
PA352222EZ3Medicare PIN