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General NPI Number Information
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NPI Number | 1538195284
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Entity Type | Individual
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Provider Name | JENNIFER DANA DIABO MD
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Gender | Female
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 02/15/2016
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Provider Practice Location Address
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Address Line | 2346 E ALLEGHENY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19134-4434
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Country | US
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Telephone | 215-423-1011
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Fax | 215-423-6743
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Provider Business Mailing Address
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Address Line | 1609 ASHBOURNE RD
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City | ELKINS PARK
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State | PA
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Zip | 19027-2534
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Country | US
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Telephone | 215-432-6313
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Fax | 215-423-6743
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD417182
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License Number State | PA
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