Provider Demographics
NPI:1598784324
Name:CURTIS, JACQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUE
Middle Name:
Last Name:CURTIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 N BROAD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1531
Mailing Address - Country:US
Mailing Address - Phone:121-546-8722
Mailing Address - Fax:215-468-7221
Practice Address - Street 1:1740 SOUTH ST
Practice Address - Street 2:STE 401
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19146-1572
Practice Address - Country:US
Practice Address - Phone:215-468-7220
Practice Address - Fax:215-468-7221
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055881L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015624800005Medicaid
PAG20924Medicare UPIN
PA0015624800005Medicaid