Provider Demographics
NPI:1497758924
Name:LONGACRE, JANE MOONEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:MOONEY
Last Name:LONGACRE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:819 ALENE RD
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2607
Mailing Address - Country:US
Mailing Address - Phone:215-646-0648
Mailing Address - Fax:
Practice Address - Street 1:3031 WALTON RD
Practice Address - Street 2:STE C101
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-2369
Practice Address - Country:US
Practice Address - Phone:610-825-3500
Practice Address - Fax:610-825-8502
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD026796E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB29876Medicare UPIN