Healthcare Provider Details

I. General information

NPI: 1568033389
Provider Name (Legal Business Name): JARED DAAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST
PHILADELPHIA PA
19140-5103
US

IV. Provider business mailing address

3322 N BROAD ST
PHILADELPHIA PA
19140-5185
US

V. Phone/Fax

Practice location:
  • Phone: 267-398-5954
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT222665
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: