Provider Demographics
NPI:1093909533
Name:KLEMENS, JESSICA M (DO)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:KLEMENS
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2701 BLAIR MILL RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1041
Mailing Address - Country:US
Mailing Address - Phone:215-443-0660
Mailing Address - Fax:215-443-8422
Practice Address - Street 1:2701 BLAIR MILL RD
Practice Address - Street 2:SUITE C
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1041
Practice Address - Country:US
Practice Address - Phone:215-443-0660
Practice Address - Fax:215-443-8422
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2017-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS013625207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1093909533OtherNPI
120722TGWMedicare PIN