Provider Demographics
NPI:1073873022
Name:PREDINA, JARROD D (MD)
Entity Type:Individual
Prefix:
First Name:JARROD
Middle Name:D
Last Name:PREDINA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:WEST PAVILION 1ST FLR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4306
Mailing Address - Country:US
Mailing Address - Phone:215-615-5864
Mailing Address - Fax:215-349-8432
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:WEST PAVILION 1ST FLR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4306
Practice Address - Country:US
Practice Address - Phone:215-615-5864
Practice Address - Fax:215-349-8432
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2023-04-12
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Provider Licenses
StateLicense IDTaxonomies
PAMD456124208G00000X
MAL-251548208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA450257N4GMedicare PIN