Provider Demographics
NPI:1104844208
Name:BOSWINKEL, JAN P (MD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:P
Last Name:BOSWINKEL
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9234
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:CHILDREN'S HOSPITAL OF PHILA - GENERAL PEDIATRICS
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-2164
Practice Address - Fax:215-590-2180
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD421926208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100971200Medicaid
NJ0042757Medicaid
PA100971200Medicaid
NJ0042757Medicaid