MEDICARE: DR. JENNIFER LEIGH PARISH 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	207N00000X	Dermatology Physician	MD418587	PA

General Provider Information

NPI Number	:	1164412144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER LEIGH PARISH M.D.

Provider Business Mailing Address
First Line	:	1760 MARKET ST
Second Line	:	STE 301
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-4134
Country	:	US
Telephone Number	:	215-563-8333
Fax Number	:	215-563-3044

Provider Business Practice Location Address
First Line	:	1760 MARKET ST
Second Line	:	STE 301
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-4134
Country	:	US
Telephone Number	:	215-563-8333
Fax Number	:	215-563-3044

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/08/2007

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