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General NPI Number Information
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NPI Number | 1780476911
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Entity Type | Organization
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Legal Business Name | JEFFERSON COMMUNITY PHYSICIANS
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Dates
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Enumeration Date | 05/22/2025
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 2700 S EAGLE RD
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City | NEWTOWN
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State | PA
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Zip | 18940-1570
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Country | US
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Telephone | 844-542-2273
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 828937
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City | PHILADELPHIA
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State | PA
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Zip | 19182-8937
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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 | ENTERPRISE DIRECT PROVIDER ENROLL
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Name | RACHEL RENAE DANTIS
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Credential |
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Telephone | 609-238-7660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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