Provider Demographics
NPI:1043402431
Name:EPISCOPIO, JENNIFER SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUSAN
Last Name:EPISCOPIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 N BROOKSIDE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESCOSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9652
Mailing Address - Country:US
Mailing Address - Phone:610-398-1171
Mailing Address - Fax:610-395-5419
Practice Address - Street 1:682 N BROOKSIDE RD
Practice Address - Street 2:SUITE B
Practice Address - City:WESCOSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18106-9652
Practice Address - Country:US
Practice Address - Phone:610-398-1171
Practice Address - Fax:610-395-5419
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT186112207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
154335Medicare PIN