MEDICARE: RICHARD L. JAHNLE M.D.

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
1	207W00000X	Ophthalmology Physician	MD0290208E	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180008668	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	23-2075896	OTHER	PA	TAX ID

General Provider Information

NPI Number	:	1083619878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD L. JAHNLE M.D.

Provider Business Mailing Address
First Line	:	2010 WEST CHESTER PIKE
Second Line	:	WELLNESS CENTER; SUITE 310
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-2737
Country	:	US
Telephone Number	:	610-446-2260
Fax Number	:	610-446-3360

Provider Business Practice Location Address
First Line	:	2010 WEST CHESTER PIKE
Second Line	:	WELLNESS CENTER; SUITE 310
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-2737
Country	:	US
Telephone Number	:	610-446-2260
Fax Number	:	610-446-3360

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	05/10/2012

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