MEDICARE: DR. JACQUELINE EWING D.O.

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	25MB05811600	NJ
2	207Q00000X	Family Medicine Physician	OS007580L	PA

General Provider Information

NPI Number	:	1740269018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE EWING D.O.

Provider Business Mailing Address
First Line	:	3855 W CHESTER PIKE
Second Line	:	SUITE 300
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-2304
Country	:	US
Telephone Number	:	484-427-8000
Fax Number	:	484-427-8020

Provider Business Practice Location Address
First Line	:	3855 W CHESTER PIKE
Second Line	:	SUITE 300
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-2304
Country	:	US
Telephone Number	:	484-427-8000
Fax Number	:	484-427-8020

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

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	09/30/2015

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