Provider Demographics
NPI:1720010390
Name:JACKSON, JAY RUSWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:RUSWIN
Last Name:JACKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-2316
Mailing Address - Fax:717-812-2549
Practice Address - Street 1:2050 S QUEEN ST
Practice Address - Street 2:STE 200
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4829
Practice Address - Country:US
Practice Address - Phone:717-812-2316
Practice Address - Fax:717-848-5540
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016808E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA060973OtherHIGHMARK BLUE SHIELD
PA01475302OtherCAPITAL BLUE CROSS-WMG
PA030261OtherJOHNS HOPKINS
PA433281OtherMAMSI-WMG
PA1519360OtherGATEWAY-WMG
PA80827OtherUNISON-WMG
PA000768337Medicaid
PA0068408000OtherAMERIHEALTH 65 PA
PA1142788OtherAMERIHEALTH MERCY-WMG
PA4296841OtherAETNA
MD525991OtherCAREFIRST MD BCBS
PA7312OtherGEISINGER
PA7312OtherGEISINGER
PA1142788OtherAMERIHEALTH MERCY-WMG
PA000768337Medicaid
PA060973FLTMedicare PIN