Provider Demographics
NPI:1457381725
Name:JIANG, FENGJUN (MD)
Entity Type:Individual
Prefix:DR
First Name:FENGJUN
Middle Name:
Last Name:JIANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FENGJUN
Other - Middle Name:FRANK
Other - Last Name:JIANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-5503
Mailing Address - Fax:717-851-5507
Practice Address - Street 1:228 SAINT CHARLES WAY STE 200
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4661
Practice Address - Country:US
Practice Address - Phone:717-851-5503
Practice Address - Fax:717-851-5507
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424105207R00000X, 2084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA167112OtherUNISON-WMG
PA20043931OtherAMERIHEALTH MERCY-WMG
PA2137711OtherMAMSI-WMG
PA109185OtherJOHNS HOPKINS
PA100452OtherGEISINGER
PA101213615Medicaid
PA737330OtherHIGHMARK BLUE SHIELD
MD645183OtherCAREFIRST MD BCBS
PA1544217OtherGATEWAY-WMG
PA50046369OtherCAPITAL BLUE CROSS-WMG
PA7374849OtherAETNA
PA737330OtherHIGHMARK BLUE SHIELD
MD645183OtherCAREFIRST MD BCBS
PAI30622Medicare UPIN
PAP00230875Medicare PIN