Healthcare Provider Details

I. General information

NPI: 1578123303
Provider Name (Legal Business Name): DANIELA LUISA JAEGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 BRODHEAD RD
BETHLEHEM PA
18017-8938
US

IV. Provider business mailing address

257 BRODHEAD RD
BETHLEHEM PA
18017-8938
US

V. Phone/Fax

Practice location:
  • Phone: 484-822-5700
  • Fax:
Mailing address:
  • Phone: 484-822-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD481061
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA11888100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: