Healthcare Provider Details

I. General information

NPI: 1316350366
Provider Name (Legal Business Name): CHARLENE JONES M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2014
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BALTIMORE PIKE STE 14LL
SPRINGFIELD PA
19064-2800
US

IV. Provider business mailing address

200 HYGEIA DR STE 1360
NEWARK DE
19713-2049
US

V. Phone/Fax

Practice location:
  • Phone: 610-690-2106
  • Fax:
Mailing address:
  • Phone: 302-320-9440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD461642
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberC1-0024319
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberMD461642
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: