Provider Demographics
NPI:1053495416
Name:CEDERSTROM, JANICE J (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:J
Last Name:CEDERSTROM
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 1:834 CHESTNUT ST
Mailing Address - Street 2:SUITE T-140
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5127
Mailing Address - Country:US
Mailing Address - Phone:215-574-1776
Mailing Address - Fax:215-574-1776
Practice Address - Street 1:834 CHESTNUT ST
Practice Address - Street 2:SUITE T-140
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5127
Practice Address - Country:US
Practice Address - Phone:215-574-1776
Practice Address - Fax:215-574-1776
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026278E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014411530004Medicaid
PAB40711Medicare UPIN
PACE175611Medicare ID - Type Unspecified