MEDICARE: JENNSERVILLE OBSTETRICS AND GYNECOLOGY, LLC

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	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235125329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNSERVILLE OBSTETRICS AND GYNECOLOGY, LLC

Provider Business Mailing Address
First Line	:	1011 W BALTIMORE PIKE
Second Line	:	SUITE 102
City	:	WEST GROVE
State	:	PA
Zip	:	19390-9446
Country	:	US
Telephone Number	:	610-896-8919
Fax Number	:	610-869-8913

Provider Business Practice Location Address
First Line	:	1011 W BALTIMORE PIKE
Second Line	:	SUITE 102
City	:	WEST GROVE
State	:	PA
Zip	:	19390-9446
Country	:	US
Telephone Number	:	610-896-8919
Fax Number	:	610-869-8913

Authorized Official
Title or Position	:	OWNER
Name	:	ALLAN WAIMING HO
Credential	:	MD
Telephone Number	:	610-869-8919

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	10/01/2007

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