Provider Demographics
NPI:1114337508
Name:HWANG, JENNIFER (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HWANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 W CHESTER PIKE STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2304
Mailing Address - Country:US
Mailing Address - Phone:484-427-8000
Mailing Address - Fax:484-427-8020
Practice Address - Street 1:3855 W CHESTER PIKE STE 300
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073
Practice Address - Country:US
Practice Address - Phone:484-427-8000
Practice Address - Fax:484-427-8020
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT015771207Q00000X
PAOS019037207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine