Provider Demographics
NPI:1023104544
Name:JURNOVOY, JOEL B (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:B
Last Name:JURNOVOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3656 WAYNESFIELD DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073
Mailing Address - Country:US
Mailing Address - Phone:610-353-6463
Mailing Address - Fax:
Practice Address - Street 1:2010 WEST CHESTER PIKE
Practice Address - Street 2:SUITE 350
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2738
Practice Address - Country:US
Practice Address - Phone:610-924-0135
Practice Address - Fax:610-924-0620
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010163E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD010163EOtherLICENSE
PA0031679000Other081671 IBC PROVIDER #
PA0031679000Other081671 IBC PROVIDER #
PAB35218Medicare UPIN
PAMD010163EOtherLICENSE