MEDICARE: JENNIFER MARIE DRAGOUN 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	207Q00000X	Family Medicine Physician	MD072400L	PA

General Provider Information

NPI Number	:	1598741423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIE DRAGOUN MD

Provider Business Mailing Address
First Line	:	134 SHELDRAKE DR
Second Line	:
City	:	PAOLI
State	:	PA
Zip	:	19301-1244
Country	:	US
Telephone Number	:	610-695-4693
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 MARKET ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-1400
Country	:	US
Telephone Number	:	215-241-3256
Fax Number	:

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	04/15/2008

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