Provider Demographics
NPI:1225289549
Name:MAYER, JESSICA ROSE (DO)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSE
Last Name:MAYER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ROSE
Other - Last Name:TERRANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-4108
Mailing Address - Country:US
Mailing Address - Phone:610-567-6967
Mailing Address - Fax:610-567-6955
Practice Address - Street 1:2705 DEKALB PIKE STE 202
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401
Practice Address - Country:US
Practice Address - Phone:610-275-7240
Practice Address - Fax:610-275-0633
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015901207Q00000X
PAOT012663390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2680246OtherBLUE SHIELD
PA3871997000OtherIBC/KHPE
PA3856419OtherCOVENTRY
PA2680246OtherBLUE SHIELD