Provider Demographics
NPI:1639451867
Name:BOBADILLA, JENNA MARIE (PA)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:BOBADILLA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:M
Other - Last Name:LOMBARDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:130 S BRYN MAWR AVE
Mailing Address - Street 2:STE H321
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3121
Mailing Address - Country:US
Mailing Address - Phone:610-405-6236
Mailing Address - Fax:484-337-4082
Practice Address - Street 1:130 S BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3121
Practice Address - Country:US
Practice Address - Phone:484-337-3583
Practice Address - Fax:484-337-3614
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant