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General NPI Number Information
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NPI Number | 1043530512
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Entity Type | Individual
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Provider Name | JESSICA A PALAKSHAPPA M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 05/08/2017
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Provider Practice Location Address
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Address Line | 3400 CIVIC CENTER BLVD PENN LUNG CENTER, 2ND FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19104-5127
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Country | US
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Telephone | 215-349-5488
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 CIVIC CENTER BLVD PENN LUNG CENTER, 2ND FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19104-5127
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L-243768
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | MD451313
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License Number State | PA
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