Provider Demographics
NPI:1073748844
Name:JENNERSVILLE MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:JENNERSVILLE MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-869-3620
Mailing Address - Street 1:1011 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9446
Mailing Address - Country:US
Mailing Address - Phone:610-869-3620
Mailing Address - Fax:610-869-0358
Practice Address - Street 1:1011 W BALTIMORE PIKE
Practice Address - Street 2:SUITE 301
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9446
Practice Address - Country:US
Practice Address - Phone:610-869-3620
Practice Address - Fax:610-869-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004477L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty