Provider Demographics
NPI:1508050394
Name:MCQUADE, JENNIFER ANN (M D)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:MCQUADE
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 W 23RD ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2858
Mailing Address - Country:US
Mailing Address - Phone:814-453-2777
Mailing Address - Fax:814-453-2779
Practice Address - Street 1:145 W 23RD ST STE 201
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2858
Practice Address - Country:US
Practice Address - Phone:814-453-2777
Practice Address - Fax:814-453-2779
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238428208C00000X
PAMD462511208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery