Healthcare Provider Details

I. General information

NPI: 1316444334
Provider Name (Legal Business Name): RYAN JAMIOLKOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD 2ND FLR. SOUTH PAVILION
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

3400 CIVIC CENTER BLVD PCAM 15TH FLOOR
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3487
  • Fax: 215-349-5534
Mailing address:
  • Phone: 215-662-3487
  • Fax: 215-349-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD489413
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: