Healthcare Provider Details

I. General information

NPI: 1619314838
Provider Name (Legal Business Name): JENNIFER L. ROBERTSHAW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W LEMON ST
LITITZ PA
17543-2311
US

IV. Provider business mailing address

300 W LEMON ST
LITITZ PA
17543-2311
US

V. Phone/Fax

Practice location:
  • Phone: 171-544-8696
  • Fax: 717-544-8697
Mailing address:
  • Phone: 171-544-8696
  • Fax: 717-544-8697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD458212
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: