Provider Demographics
NPI:1356343354
Name:DEVLIN, JEANINE G (MD)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:G
Last Name:DEVLIN
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 1:12265 TOWNSEND RD
Mailing Address - Street 2:STE 500
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1201
Mailing Address - Country:US
Mailing Address - Phone:215-859-1009
Mailing Address - Fax:215-698-3730
Practice Address - Street 1:7901 BUSTLETON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3328
Practice Address - Country:US
Practice Address - Phone:215-742-7890
Practice Address - Fax:215-742-7862
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072933L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019091350001Medicaid
058306Medicare ID - Type Unspecified
PA0019091350001Medicaid