Provider Demographics
NPI:1225053465
Name:RETIG, JEFFREY N (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:N
Last Name:RETIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:825 OLD LANCASTER RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3231
Mailing Address - Country:US
Mailing Address - Phone:610-527-3800
Mailing Address - Fax:610-527-0334
Practice Address - Street 1:825 OLD LANCASTER RD
Practice Address - Street 2:SUITE 320
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3231
Practice Address - Country:US
Practice Address - Phone:610-527-3800
Practice Address - Fax:610-527-0334
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD031650207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010783490006Medicaid
PA0010783490006Medicaid