Healthcare Provider Details

I. General information

NPI: 1134574148
Provider Name (Legal Business Name): EVA QINYI JIANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 THOMAS JONES WAY STE 210
EXTON PA
19341-2553
US

IV. Provider business mailing address

PO BOX 22573
NEW YORK NY
10087-2573
US

V. Phone/Fax

Practice location:
  • Phone: 610-280-3636
  • Fax: 610-280-1569
Mailing address:
  • Phone: 610-482-4795
  • Fax: 856-528-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036.152553
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD473228
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier103282863
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: