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General NPI Number Information
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NPI Number | 1689115008
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Entity Type | Individual
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Provider Name | JENNIFER BOLES SCOTT M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/17/2017
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Last Update Date | 06/07/2025
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Provider Practice Location Address
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Address Line | 3401 CIVIC CENTER BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4319
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Country | US
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Telephone | 215-590-2169
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Fax |
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Provider Business Mailing Address
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Address Line | 688 BARCLAY LN
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City | BROOMALL
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State | PA
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Zip | 19008-1011
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Country | US
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Telephone | 610-550-9642
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036.152099
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number | MT226907
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License Number State | PA
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