Healthcare Provider Details

I. General information

NPI: 1730180316
Provider Name (Legal Business Name): JAMIE VINCENTI REDWING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date: 03/22/2006
Reactivation Date: 03/29/2006

III. Provider practice location address

7979 STATE RD BLACK DOCTORS CONSORTIUM - CEDAR BLDG
PHILADELPHIA PA
19136-3407
US

IV. Provider business mailing address

7979 STATE RD BLACK DOCTORS CONSORTIUM - CEDAR BLDG
PHILADELPHIA PA
19136-3407
US

V. Phone/Fax

Practice location:
  • Phone: 267-501-1627
  • Fax: 267-817-3031
Mailing address:
  • Phone: 267-501-1627
  • Fax: 267-817-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD443714
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: