Provider Demographics
NPI:1770815268
Name:JENNIFER DUPRE' PC
Entity Type:Organization
Organization Name:JENNIFER DUPRE' PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:ENGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-793-9999
Mailing Address - Street 1:1108 N BETHLEHEM PIKE
Mailing Address - Street 2:PO BOX 736
Mailing Address - City:SPRING HOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:19477-0736
Mailing Address - Country:US
Mailing Address - Phone:215-793-9999
Mailing Address - Fax:215-793-9972
Practice Address - Street 1:1108 NORTH BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:SPRING HOUSE
Practice Address - State:PA
Practice Address - Zip Code:19477-0736
Practice Address - Country:US
Practice Address - Phone:215-793-7777
Practice Address - Fax:215-793-9972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011903207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA063263Medicare UPIN