Provider Demographics
NPI:1760725089
Name:GEORGE, JENIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENIE
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3624 MARKET ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2614
Mailing Address - Country:US
Mailing Address - Phone:215-662-7772
Mailing Address - Fax:215-349-8038
Practice Address - Street 1:3624 MARKET ST
Practice Address - Street 2:2ND FL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-7772
Practice Address - Fax:215-349-8038
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4650802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology