Provider Demographics
NPI:1518498278
Name:DOUGLAS, JENNIFER ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ELLEN
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3400 SPRUCE STREET, 5TH FLOOR RAVDIN BUILDING
Mailing Address - Street 2:HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-662-2777
Mailing Address - Fax:215-662-4515
Practice Address - Street 1:3400 SPRUCE STREET, 5TH FLOOR RAVDIN BUILDING
Practice Address - Street 2:HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-2777
Practice Address - Fax:215-662-4515
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD470677207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology