Provider Demographics
NPI:1508640947
Name:JEAN MARY LLC
Entity Type:Organization
Organization Name:JEAN MARY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WANNA
Authorized Official - Middle Name:STEPHANIE
Authorized Official - Last Name:JEAN MARY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-334-3348
Mailing Address - Street 1:250 FAME AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1587
Mailing Address - Country:US
Mailing Address - Phone:717-632-5264
Mailing Address - Fax:717-632-1165
Practice Address - Street 1:3812 MARKET ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4356
Practice Address - Country:US
Practice Address - Phone:717-458-2027
Practice Address - Fax:717-632-1165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty