Provider Demographics
NPI:1730120973
Name:RANTON, JENNIFER A (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:RANTON
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:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:708 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:HELLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18055-1513
Practice Address - Country:US
Practice Address - Phone:610-838-7069
Practice Address - Fax:610-838-7060
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD444623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR247617Medicaid
NC5485293OtherFH/CCN PROVIDER NO
NCP00108928OtherRRMC
NC89135EUMedicaid
NC135EUOtherBCBS PROVIDER NO.
NC934870OtherPRONET
NC5485293OtherFH/CCN PROVIDER NO
NCH93799Medicare UPIN
NCP00108928OtherRRMC