Healthcare Provider Details

I. General information

NPI: 1598746026
Provider Name (Legal Business Name): RANDY JAEGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 SCHOENERSVILLE RD
BETHLEHEM PA
18017-7307
US

IV. Provider business mailing address

2775 SCHOENERSVILLE RD
BETHLEHEM PA
18017-7307
US

V. Phone/Fax

Practice location:
  • Phone: 610-861-8080
  • Fax: 610-807-0366
Mailing address:
  • Phone: 610-861-8080
  • Fax: 610-807-0366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD050270L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD050270L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: