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1144262288

NPI Code Detail

MEDICARE: DR. CHERYL A JACKSON M.D.

MEDICARE: DR. CHERYL A JACKSON M.D.

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	207R00000X	Internal Medicine Physician	C1-0010168	DE
2	207R00000X	Internal Medicine Physician	D0046694	MD
3	207R00000X	Internal Medicine Physician	MD469234	PA

General Provider Information

NPI Number	:	1144262288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERYL A JACKSON M.D.

Provider Business Mailing Address
First Line	:	5901 MARKET ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-3117
Country	:	US
Telephone Number	:	215-528-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 MARKET ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-3117
Country	:	US
Telephone Number	:	215-528-5600
Fax Number	:

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	05/06/2021

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Directions to “ DR. CHERYL A JACKSON M.D.” Practice Location

Language	Start Address	Practice Location

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