Healthcare Provider Details

I. General information

NPI: 1578536223
Provider Name (Legal Business Name): SUMAN S JASWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 JAMESTOWN ST SUITE 107
PHILADELPHIA PA
19128
US

IV. Provider business mailing address

207 N BROAD ST 3RD FLR.
PHILADELPHIA PA
19107-1500
US

V. Phone/Fax

Practice location:
  • Phone: 215-482-1607
  • Fax: 215-482-3768
Mailing address:
  • Phone: 215-463-5333
  • Fax: 215-463-8085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD074200L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: