MEDICARE: JENNIFER DUPRE' PC

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	207QA0505X	Adult Medicine Physician	OS011903	PA

General Provider Information

NPI Number	:	1770815268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER DUPRE' PC

Provider Business Mailing Address
First Line	:	1108 N BETHLEHEM PIKE
Second Line	:	PO BOX 736
City	:	SPRING HOUSE
State	:	PA
Zip	:	19477-0736
Country	:	US
Telephone Number	:	215-793-9999
Fax Number	:	215-793-9972

Provider Business Practice Location Address
First Line	:	1108 NORTH BETHLEHEM PIKE
Second Line	:
City	:	SPRING HOUSE
State	:	PA
Zip	:	19477-0736
Country	:	US
Telephone Number	:	215-793-7777
Fax Number	:	215-793-9972

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	SHARON DENISE ENGLER
Credential	:
Telephone Number	:	215-793-9999

Provider Enumeration Date	:	02/08/2010
Last Update Date	:	02/08/2010

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