Provider Demographics
NPI:1942396007
Name:SIMMONS, JENNIFER C (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:SIMMONS
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:PO BOX 8500-8735
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-456-7000
Mailing Address - Fax:215-254-2599
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-254-2730
Practice Address - Fax:215-254-2735
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422936208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1610575OtherHIGHMARK BLUE SHIELD
PA100933086-03OtherAMERICHOICE
PA30017114OtherKEYSTONE MERCY
PA8062810OtherCIGNA
PA2290910000OtherKEYSTONE IBC
PA1009330860002Medicaid
PA1610575OtherPERSONAL CHOICE
PA3630679OtherAETNA
PA2435645OtherUNITED HEALTHCARE
PA30017114OtherKEYSTONE MERCY
PA1009330860002Medicaid