Provider Demographics
NPI:1265441380
Name:CARMAN, JENNIFER J (MS LDN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:CARMAN
Suffix:
Gender:F
Credentials:MS LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3557 STELTZ RD
Mailing Address - Street 2:
Mailing Address - City:NEW FREEDOM
Mailing Address - State:PA
Mailing Address - Zip Code:17349-9281
Mailing Address - Country:US
Mailing Address - Phone:443-956-7227
Mailing Address - Fax:
Practice Address - Street 1:3557 STELTZ RD
Practice Address - Street 2:
Practice Address - City:NEW FREEDOM
Practice Address - State:PA
Practice Address - Zip Code:17349-9281
Practice Address - Country:US
Practice Address - Phone:443-956-7227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD02217133V00000X
PAH5563196133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD132190100Medicaid
MDK802Medicare PIN