Provider Demographics
NPI:1174732143
Name:MULDOON, JENNIFER A B (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A B
Last Name:MULDOON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ALLYN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2020 MERIDIAN ST STE 220
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-4338
Mailing Address - Country:US
Mailing Address - Phone:765-683-3280
Mailing Address - Fax:
Practice Address - Street 1:11135 LEE HWY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5004
Practice Address - Country:US
Practice Address - Phone:703-273-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040395207V00000X
IN01081144A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00040395OtherWA ST LIC NUMBER