Provider Demographics
NPI:1346674926
Name:TELLES, JESSE (MEDICAL CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:TELLES
Suffix:
Gender:F
Credentials:MEDICAL CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 S BROAD ST
Mailing Address - Street 2:18TH FLOOR
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-5021
Mailing Address - Country:US
Mailing Address - Phone:215-985-2500
Mailing Address - Fax:267-765-2325
Practice Address - Street 1:1200 CALLOWHILL ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19123-3658
Practice Address - Country:US
Practice Address - Phone:215-825-8220
Practice Address - Fax:215-825-8254
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator