Provider Demographics
NPI:1730180316
Name:REDWING, JAMIE VINCENTI (MD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:VINCENTI
Last Name:REDWING
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 1:7979 STATE RD
Mailing Address - Street 2:BLACK DOCTORS CONSORTIUM - CEDAR BLDG
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-3407
Mailing Address - Country:US
Mailing Address - Phone:267-501-1627
Mailing Address - Fax:267-817-3031
Practice Address - Street 1:7979 STATE RD
Practice Address - Street 2:BLACK DOCTORS CONSORTIUM - CEDAR BLDG
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-3407
Practice Address - Country:US
Practice Address - Phone:267-501-1627
Practice Address - Fax:267-817-3031
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2025-10-30
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
PAMD443714207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE7517AMedicare ID - Type Unspecified
H63526Medicare UPIN