Provider Demographics
NPI:1164652442
Name:HELLER, JENNIFER OBOZA (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:OBOZA
Last Name:HELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 FLOWERS DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-1701
Mailing Address - Country:US
Mailing Address - Phone:717-691-8750
Mailing Address - Fax:717-691-8755
Practice Address - Street 1:9 FLOWERS DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1701
Practice Address - Country:US
Practice Address - Phone:717-691-8750
Practice Address - Fax:717-691-8755
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437933207V00000X
NY254058207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA18086N54Medicare PIN