Provider Demographics
NPI:1891146882
Name:BRKICH, JENNA LOHRE (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:LOHRE
Last Name:BRKICH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:LOHRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1546 PRATT ST.
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124
Mailing Address - Country:US
Mailing Address - Phone:215-824-4141
Mailing Address - Fax:
Practice Address - Street 1:10800 KNIGHTS RD STE 212
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-4200
Practice Address - Country:US
Practice Address - Phone:215-824-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006767213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery