Provider Demographics
NPI:1376522391
Name:KUMMERY, JEFFREY (PA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:KUMMERY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W STATE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2250
Mailing Address - Country:US
Mailing Address - Phone:215-348-3936
Mailing Address - Fax:215-348-7428
Practice Address - Street 1:800 W STATE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2250
Practice Address - Country:US
Practice Address - Phone:215-348-3936
Practice Address - Fax:215-348-7428
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003331L363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP15416Medicare UPIN
PA111202Medicare ID - Type Unspecified