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General NPI Number Information
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NPI Number | 1659301356
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Entity Type | Individual
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Provider Name | JESSE IWANSKI MD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 2501 PARKERS LN
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3209
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Country | US
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Telephone | 703-664-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 1135 PINE ST 2ND FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19107-6212
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Country | US
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Telephone | 215-923-0718
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MT182133
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License Number State | PA
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