Healthcare Provider Details

I. General information

NPI: 1235125329
Provider Name (Legal Business Name): JENNSERVILLE OBSTETRICS AND GYNECOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 W BALTIMORE PIKE SUITE 102
WEST GROVE PA
19390-9446
US

IV. Provider business mailing address

1011 W BALTIMORE PIKE SUITE 102
WEST GROVE PA
19390-9446
US

V. Phone/Fax

Practice location:
  • Phone: 610-896-8919
  • Fax: 610-869-8913
Mailing address:
  • Phone: 610-896-8919
  • Fax: 610-869-8913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALLAN WAIMING HO
Title or Position: OWNER
Credential: MD
Phone: 610-869-8919