MEDICARE: DR. JEFFREY BATT ETTINGER 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	208000000X	Pediatrics Physician	MD018590E	PA

General Provider Information

NPI Number	:	1396737797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY BATT ETTINGER MD

Provider Business Mailing Address
First Line	:	7500 CENTRAL AVE
Second Line	:	STE 205
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2430
Country	:	US
Telephone Number	:	215-728-7711
Fax Number	:	215-725-2795

Provider Business Practice Location Address
First Line	:	7500 CENTRAL AVE
Second Line	:	STE 205
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2430
Country	:	US
Telephone Number	:	215-728-7711
Fax Number	:	215-725-2795

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	07/08/2007

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