Provider Demographics
NPI:1861455537
Name:KASPER, JAMIE A (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:A
Last Name:KASPER
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 1:10 PRESIDENTIAL BLVD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1107
Mailing Address - Country:US
Mailing Address - Phone:610-664-9700
Mailing Address - Fax:610-664-6391
Practice Address - Street 1:10 PRESIDENTIAL BLVD
Practice Address - Street 2:SUITE 124
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1107
Practice Address - Country:US
Practice Address - Phone:610-664-9700
Practice Address - Fax:610-664-6391
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050753L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001602399Medicaid
PAG27283Medicare UPIN
PA000655E2PMedicare ID - Type Unspecified