Provider Demographics
NPI:1750505939
Name:JETER, TAMIKA (MD)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:
Last Name:JETER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TAMIKA
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1600 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-5008
Mailing Address - Country:US
Mailing Address - Phone:610-327-7000
Mailing Address - Fax:
Practice Address - Street 1:1600 E HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5008
Practice Address - Country:US
Practice Address - Phone:610-327-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 431199207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019057560001OtherPROMISE
PA30043160OtherKEYSTONE MERCY
PA2842342000OtherKEYSTONE
PA1962660OtherHIGHMARK BS
PA1962660OtherBS
PA101905759Medicaid
PA30043160OtherKEYSTONE MERCY
PA101905759Medicaid