Healthcare Provider Details

I. General information

NPI: 1023200045
Provider Name (Legal Business Name): MELINDA JEN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 MARKET ST FL 2 CHILDREN'S HOSPITAL OF PHILADELPHIA - DERMATOLOGY DIV
PHILADELPHIA PA
19104-3366
US

IV. Provider business mailing address

100 E PENN SQ 9TH FLOOR
PHILADELPHIA PA
19107-3323
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-9119
  • Fax: 215-590-4948
Mailing address:
  • Phone: 267-425-9234
  • Fax: 267-425-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberMD442934
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: