Provider Demographics
NPI:1528357043
Name:KNICKELBEIN, JARED EVAN (MD/PHD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:EVAN
Last Name:KNICKELBEIN
Suffix:
Gender:M
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MSC10 5610
Mailing Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-6120
Mailing Address - Fax:
Practice Address - Street 1:203 LOTHROP ST FL 8
Practice Address - Street 2:UPMC EYE CENTER
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2548
Practice Address - Country:US
Practice Address - Phone:412-647-2256
Practice Address - Fax:412-647-5119
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT197844207W00000X
NMRS2013-0363207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology