Provider Demographics
NPI:1679861801
Name:LLOYD-HARRIS, JENNIFER E (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:LLOYD-HARRIS
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 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:3 GATES
Mailing Address - City:PHIADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4328
Mailing Address - Country:US
Mailing Address - Phone:215-662-2891
Mailing Address - Fax:
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:3 GATES
Practice Address - City:PHIADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4328
Practice Address - Country:US
Practice Address - Phone:215-662-2891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036140595208800000X
PAMD471519208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01742716Medicare PIN
F400310774Medicare PIN
5514060005Medicare NSC