Provider Demographics
NPI:1831485804
Name:WASEY, JACK OLIVER (MA MSCI MSC BM BCH)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:OLIVER
Last Name:WASEY
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Gender:M
Credentials:MA MSCI MSC BM BCH
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Mailing Address - Street 1:3401 CIVIC CENTER BLVD
Mailing Address - Street 2:SUITE 9329
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4319
Mailing Address - Country:US
Mailing Address - Phone:215-590-1858
Mailing Address - Fax:267-425-9331
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:SUITE 9329
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:180-087-9246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2016-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMT207967207LP3000X, 207L00000X
PAMD457791207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology