Provider Demographics
NPI:1619929932
Name:JAN, AMBEREEN M (MD)
Entity Type:Individual
Prefix:MRS
First Name:AMBEREEN
Middle Name:M
Last Name:JAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:860 SPRINGDALE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2847
Mailing Address - Country:US
Mailing Address - Phone:610-524-3703
Mailing Address - Fax:610-524-5990
Practice Address - Street 1:860 SPRINGDALE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2847
Practice Address - Country:US
Practice Address - Phone:610-524-3703
Practice Address - Fax:610-524-5990
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD047325L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01557749Medicaid
PAF98180Medicare UPIN
PA614424Medicare ID - Type Unspecified