Provider Demographics
NPI:1477994564
Name:LE, JAMIE JOANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:JOANNE
Last Name:LE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:JOANNE
Other - Last Name:BAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:833 CHESTNUT ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4414
Mailing Address - Country:US
Mailing Address - Phone:215-830-8700
Mailing Address - Fax:267-339-3761
Practice Address - Street 1:2400 MARYLAND RD
Practice Address - Street 2:SUITE 20
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090
Practice Address - Country:US
Practice Address - Phone:215-830-8700
Practice Address - Fax:215-830-8715
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056248363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA056248OtherSTATE LICENSURE