Provider Demographics
NPI:1275539710
Name:CAMPBELL, JENNIE (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:
Last Name:CAMPBELL
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 1:605 N BETHLEHEM PIKE
Mailing Address - Street 2:
Mailing Address - City:LOWER GWYNEDD
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2501
Mailing Address - Country:US
Mailing Address - Phone:215-643-2119
Mailing Address - Fax:215-643-3568
Practice Address - Street 1:605 N BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:LOWER GWYNEDD
Practice Address - State:PA
Practice Address - Zip Code:19002-2501
Practice Address - Country:US
Practice Address - Phone:215-643-2119
Practice Address - Fax:215-643-3568
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009956L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA25969Medicare PIN