Provider Demographics
NPI:1619039260
Name:JENAB-WOLCOTT, JENIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JENIA
Middle Name:
Last Name:JENAB-WOLCOTT
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 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:2 COOPER PLZ
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:855-632-2667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD76252207RH0003X
PAMD436012207RH0003X, 207RX0202X
DEC10010448207RH0003X
NJ25MA09275100207RH0003X
PA436012207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD76252OtherMEDICAL LICENSE
DEC10010448OtherMEDICAL LICENSE
PA436012OtherMEDICAL LICENSE
PA192154P4UMedicare PIN
PA436012OtherMEDICAL LICENSE
DE289752ZBMAMedicare PIN