MEDICARE: SOFIA K JENSEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	MT195441	PA
2	2084P0800X	Psychiatry Physician	MD443957	PA

General Provider Information

NPI Number	:	1053546119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOFIA K JENSEN MD

Provider Business Mailing Address
First Line	:	755 W LANCASTER AVE # 1020
Second Line	:
City	:	BRYN MAWR
State	:	PA
Zip	:	19010-3401
Country	:	US
Telephone Number	:	610-215-7050
Fax Number	:	610-273-5986

Provider Business Practice Location Address
First Line	:	191 PRESIDENTIAL BLVD STE W10
Second Line	:
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-1205
Country	:	US
Telephone Number	:	610-215-7050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2009
Last Update Date	:	09/11/2021

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