Healthcare Provider Details

I. General information

NPI: 1619913803
Provider Name (Legal Business Name): JENNIFER LEE KITCHEN MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1084 TAYLORSVILLE RD STE 103
WASHINGTON CROSSING PA
18977-1311
US

IV. Provider business mailing address

1084 TAYLORSVILLE RD STE 103
WASHINGTON CROSSING PA
18977-1311
US

V. Phone/Fax

Practice location:
  • Phone: 215-595-2130
  • Fax: 267-394-6463
Mailing address:
  • Phone: 215-595-2130
  • Fax: 267-394-6463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD429021
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: