Provider Demographics
NPI:1740269018
Name:EWING, JACQUELINE (DO)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:EWING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 W CHESTER PIKE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2304
Mailing Address - Country:US
Mailing Address - Phone:484-427-8000
Mailing Address - Fax:484-427-8020
Practice Address - Street 1:3855 W CHESTER PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2304
Practice Address - Country:US
Practice Address - Phone:484-427-8000
Practice Address - Fax:484-427-8020
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05811600207Q00000X
PAOS007580L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF97492Medicare UPIN
NJ463897Medicare ID - Type Unspecified
NJF97492Medicare UPIN