MEDICARE: JOEL J. JORGENSON 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	2085R0202X	Diagnostic Radiology Physician	MD074015L	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
2	7294643	OTHER	PA	AETNA
3	1318538	OTHER	PA	HIGHMARK BLUE SHIELD
4	30028656	OTHER	PA	KEYSTONE MERCY
5	5637183	OTHER	PA	CIGNA HMO/PPO

General Provider Information

NPI Number	:	1952351587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL J. JORGENSON MD

Provider Business Mailing Address
First Line	:	610 FOREST RD
Second Line	:
City	:	WAYNE
State	:	PA
Zip	:	19087-2324
Country	:	US
Telephone Number	:	610-688-5053
Fax Number	:

Provider Business Practice Location Address
First Line	:	4021 SOUTH 700 EAST 300
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107
Country	:	US
Telephone Number	:	800-328-3085
Fax Number	:

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/09/2007

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