MEDICARE: JEANINE G DEVLIN 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	207V00000X	Obstetrics & Gynecology Physician	MD072933L	PA

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	:	1356343354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANINE G DEVLIN MD

Provider Business Mailing Address
First Line	:	12265 TOWNSEND RD
Second Line	:	STE 500
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-1201
Country	:	US
Telephone Number	:	215-859-1009
Fax Number	:	215-698-3730

Provider Business Practice Location Address
First Line	:	7901 BUSTLETON AVE
Second Line	:	SUITE 100
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-3328
Country	:	US
Telephone Number	:	215-742-7890
Fax Number	:	215-742-7862

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	04/01/2008

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