Healthcare Provider Details

I. General information

NPI: 1265828958
Provider Name (Legal Business Name): JENNIFER TROSKO HIGGINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MEDICAL CENTER BLVD STE 205
CHESTER PA
19013-3957
US

IV. Provider business mailing address

1 MEDICAL CENTER BLVD # 1
CHESTER PA
19013-3902
US

V. Phone/Fax

Practice location:
  • Phone: 610-619-7410
  • Fax:
Mailing address:
  • Phone: 610-619-7410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC7-0005916
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD464862
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: