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1861479792 NPI number — JENNIFER A DOUGLAS MD

NPI Number: 1861479792
Health Care Provider/Practitioner: JENNIFER A DOUGLAS MD

Information about “1861479792” NPI (JENNIFER A DOUGLAS MD) exists in 1861479792 in HTML format HTML  |  1861479792 in plain Text format TXT  |  1861479792 in PDF (Portable Document Format) PDF  |  1861479792 in an XML format XML  formats.

NPI Number : 1861479792 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1861479792",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DOUGLAS",
    "FirstName": "JENNIFER",
    "MiddleName": "A",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SHAULIS",
    "OtherFirstName": "JENNIFER",
    "OtherMiddleName": "A",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "6521 ROUTE 22",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DELMONT",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "15626-2402",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "724-468-8764",
    "MailingAddressFaxNumber": "724-468-8785",
    "FirstLinePracticeLocationAddress": "6521 ROUTE 22",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DELMONT",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "15626-2402",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "724-468-8764",
    "PracticeLocationAddressFaxNumber": "724-468-8785",
    "EnumerationDate": "12/30/2005",
    "LastUpdateDate": "11/25/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "MD422567",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "208M00000X",
          "TaxonomyName": "Hospitalist Physician",
          "LicenseNumber": "MD422567",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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